Delphi: A Democratic and Cost-Effective Method of Consensus Generation in Transplantation

Area of Science:

• Nephrology
• Pathology
• Transplantation Immunology

Background:

• Renal transplant thrombotic microangiopathy (Tx-TMA) diagnosis lacks standardized criteria.
• Current diagnostic practices for Tx-TMA are varied among pathologists and nephrologists.

Purpose of the Study:

• To establish minimum diagnostic criteria (MDC) for renal transplant TMA (Tx-TMA).
• To achieve consensus among experts on Tx-TMA diagnosis using the Delphi methodology.

Main Methods:

• The Delphi methodology was employed with 23 expert panelists.
• Nine rounds of consensus followed by two rounds of digital slide image evaluation.
• Criteria were refined from 338 initial suggestions to 24 diagnostic criteria and 8 differential diagnoses.

Main Results:

• Consensus was reached on 24 criteria and 8 differential diagnoses for Tx-TMA.
• Agreement on diagnosis was achieved for three-quarters of cases by three-quarters of panelists.
• Definition refinement occurred for 4 light microscopy and 4 electron microscopy lesions.

Conclusions:

• The Delphi methodology proved effective for rapid, democratic, and cost-effective consensus generation in transplantation pathology.
• Established MDC provide a foundation for consistent diagnosis of Tx-TMA.
• This study marks the first use of the Delphi methodology within the Banff classification framework.