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Guidelines for the Diagnosis of Antibody-Mediated Rejection in Pancreas Allografts—Updated Banff Grading Schema

  1. C. B. Drachenberg1,*,
  2. J. R. Torrealba2,
  3. B. J. Nankivell3,
  4. E. B. Rangel4,
  5. I. M. Bajema5,
  6. D. U. Kim6,
  7. L. Arend7,
  8. E. R. Bracamonte8,
  9. J. S. Bromberg9,
  10. J. A. Bruijn5,
  11. D. Cantarovich10,
  12. J. R. Chapman3,
  13. A. B. Farris11,
  14. L. Gaber12,
  15. J. C. Goldberg13,
  16. A. Haririan14,
  17. E. Honsová15,
  18. S. S. Iskandar16,
  19. D. K. Klassen14,
  20. E. Kraus7,
  21. F. Lower17,
  22. J. Odorico18,
  23. J. L. Olson19,
  24. A. Mittalhenkle20,
  25. R. Munivenkatappa9,
  26. S. Paraskevas21,
  27. J. C. Papadimitriou1,
  28. P. Randhawa22,
  29. F. P. Reinholt23,
  30. K. Renaudin10,
  31. P. Revelo24,
  32. P. Ruiz25,
  33. M. D. Samaniego26,
  34. R. Shapiro21,
  35. R. J. Stratta16,
  36. D. E. R. Sutherland27,
  37. M. L. Troxell19,
  38. L. Voska15,
  39. S. V. Seshan28,
  40. L. C. Racusen7,*,
  41. S. T. Bartlett9,*

Article first published online: 3 AUG 2011

DOI: 10.1111/j.1600-6143.2011.03670.x

Issue

American Journal of Transplantation

American Journal of Transplantation

Volume 11, Issue 9, pages 1792–1802, September 2011

Additional Information

How to Cite

Drachenberg, C. B., Torrealba, J. R., Nankivell, B. J., Rangel, E. B., Bajema, I. M., Kim, D. U., Arend, L., Bracamonte, E. R., Bromberg, J. S., Bruijn, J. A., Cantarovich, D., Chapman, J. R., Farris, A. B., Gaber, L., Goldberg, J. C., Haririan, A., Honsová, E., Iskandar, S. S., Klassen, D. K., Kraus, E., Lower, F., Odorico, J., Olson, J. L., Mittalhenkle, A., Munivenkatappa, R., Paraskevas, S., Papadimitriou, J. C., Randhawa, P., Reinholt, F. P., Renaudin, K., Revelo, P., Ruiz, P., Samaniego, M. D., Shapiro, R., Stratta, R. J., Sutherland, D. E. R., Troxell, M. L., Voska, L., Seshan, S. V., Racusen, L. C. and Bartlett, S. T. (2011), Guidelines for the Diagnosis of Antibody-Mediated Rejection in Pancreas Allografts—Updated Banff Grading Schema. American Journal of Transplantation, 11: 1792–1802. doi: 10.1111/j.1600-6143.2011.03670.x

Author Information

  1. 1

    Department of Pathology, University of Maryland School of Medicine, Baltimore, MD

  2. 2

    Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI

  3. 3

    Department of Renal Medicine, University of Sidney, Westmead Hospital, Sydney, Australia

  4. 4

    Pancreas-Kidney Transplantation Unit, Hospital Israelita Albert Einstein, HIAE, San Paulo, Brazil

  5. 5

    Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands

  6. 6

    Department of Pathology, Saint Barnabas Medical Center, Livingston, NJ

  7. 7

    Department of Pathology (L.A. and L.C.R.) and Internal Medicine (E.K.), Johns Hopkins University, Baltimore, MD

  8. 8

    Department of Pathology, University of Arizona, Tucson, AZ

  9. 9

    Department of Surgery, University of Maryland School of Medicine, Baltimore, MD

  10. 10

    Department of Nephrology (D.C.) and Department of Pathology (K.R.) CHU – Hôtel Dieu, Nantes, France

  11. 11

    Department of Pathology, Emory University School of Medicine, Atlanta, GA

  12. 12

    Department of Pathology, The Methodist Hospital, Weil Cornell Medical College, Houston, TX

  13. 13

    Instituto de Nefrologia, Buenos Aires, Argentina

  14. 14

    Department of Medicine, University of Maryland School of Medicine, Baltimore, MD

  15. 15

    Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

  16. 16

    Department of Pathology (S.I.) and General Surgery (R.J.S.) Wake Forest University School of Medicine, Winston-Salem, NC

  17. 17

    Southern Illinois University School of Medicine, Springfield, IL

  18. 18

    Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI

  19. 19

    Department of Pathology, University of California, San Francisco, CA

  20. 20

    Department of Medicine (A.M.) and Department of Pathology (M.L.T.), Division of Nephrology & Hypertension, Oregon Health & Science University, Portland, OR

  21. 21

    Department of Surgery, McGill University, Montreal, Quebec, Canada

  22. 22

    Department of Pathology (P.R.) and Department of Surgery (R.S.), Division of Transplantation Pathology, University of Pittsburgh, Pittsburgh, PA

  23. 23

    Department of Pathology, University of Oslo and Oslo University Hospital, Rikshospitalet, Oslo, Norway

  24. 24

    Department of Pathology and Laboratory Medicine, University of Utah, Salt Lake City, UT

  25. 25

    Departments of Pathology and Surgery, University of Miami, Miami, FL

  26. 26

    Department of Internal Medicine, University of Michigan, Ann Arbor, MI

  27. 27

    Department of Surgery, Division of Transplantation and Diabetes Institute for Immunology and Transplantation, University of Minnesota, Minneapolis, MN

  28. 28

    Department of Pathology, Weil Cornell Medical College, New York, NY

* Cinthia B. Drachenberg, cdrac001@umaryland.edu
Senior coauthors.

Publication History

  1. Issue published online: 29 AUG 2011
  2. Article first published online: 3 AUG 2011
  3. Received 23 February 2011, revised 16 May 2011 and accepted for publication 17 May 2011

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Keywords:

  • Acinar cell injury;
  • active chronic antibody-mediated rejection;
  • amylin;
  • amyloid;
  • C4d;
  • cell-mediated rejection;
  • donor-specific antibody;
  • interacinar capillaries;
  • pancreas biopsy;
  • transplant arteriopathy

The first Banff proposal for the diagnosis of pancreas rejection (Am J Transplant 2008; 8: 237) dealt primarily with the diagnosis of acute T-cell-mediated rejection (ACMR), while only tentatively addressing issues pertaining to antibody-mediated rejection (AMR). This document presents comprehensive guidelines for the diagnosis of AMR, first proposed at the 10th Banff Conference on Allograft Pathology and refined by a broad-based multidisciplinary panel. Pancreatic AMR is best identified by a combination of serological and immunohistopathological findings consisting of (i) identification of circulating donor-specific antibodies, and histopathological data including (ii) morphological evidence of microvascular tissue injury and (iii) C4d staining in interacinar capillaries. Acute AMR is diagnosed conclusively if these three elements are present, whereas a diagnosis of suspicious for AMR is rendered if only two elements are identified. The identification of only one diagnostic element is not sufficient for the diagnosis of AMR but should prompt heightened clinical vigilance. AMR and ACMR may coexist, and should be recognized and graded independently. This proposal is based on our current knowledge of the pathogenesis of pancreas rejection and currently available tools for diagnosis. A systematized clinicopathological approach to AMR is essential for the development and assessment of much needed therapeutic interventions.

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