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Published on: August 12, 2017
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Banff Borderline Changes Suspicious for Acute T Cell-Mediated Rejection: Where Do We Stand?
J U Becker1, A Chang2, V Nickeleit3
1Institute of Pathology, University of Cologne, Cologne, Germany.
Summary
The Banff Borderline classification for kidney transplants has become ambiguous due to changes in diagnostic criteria. Many pathologists still use the older Banff 1997 definition, leading to variable practices and dissatisfaction.
Area of Science:
- Nephrology
- Transplant Pathology
- Medical Diagnostics
Background:
- The Banff classification is crucial for diagnosing kidney transplant rejection.
- The 2005 Banff consensus modified the lower threshold for interstitial inflammation (i) in borderline cases, creating ambiguity.
- The definition of Banff Borderline cases has faced challenges in consistent application.
Purpose of the Study:
- To assess the global approach of nephropathologists to the Banff Borderline diagnostic category.
- To identify variations in the application of Banff i thresholds.
- To gauge pathologist satisfaction with the current Banff Borderline definition.
Main Methods:
- A worldwide web-based survey was distributed to 503 members of the Renal Pathology Society (153 respondents).
- A database search identified the Banff i thresholds used in influential manuscripts on borderline kidney transplant pathology.
- Analysis focused on the application of Banff 1997 vs. Banff 2005 criteria.
Main Results:
- 67% of nephropathologists using the Borderline category adhere to the Banff 1997 definition (requiring Banff i1).
- 37% admitted to sometimes inflating Banff i scores to meet Borderline criteria when tubulitis is present.
- 48% expressed dissatisfaction with the current Banff Borderline definition.
Conclusions:
- There is significant variability and dissatisfaction regarding the Banff Borderline definition among transplant pathologists.
- The majority of influential publications still reference the 1997 definition, not the 2005 update.
- Pathologists' discretion for Banff i thresholds (i0 or i1) is suggested pending revision, with a call for a centralized synopsis of Banff criteria.
