Is the Banff Human Organ Transplant panel ready for prime time?

Area of Science:

• Transplant immunology
• Genomics
• Biomarker discovery

Background:

• The Banff Human Organ Transplant (B-HOT) panel was developed for standardized transcriptomic analysis of FFPE transplant biopsies.
• Current literature has advanced beyond initial proof-of-concept studies.

Purpose of the Study:

• To evaluate the readiness of the B-HOT panel for routine clinical use in transplant diagnostics.
• To identify the specific contexts and applications where B-HOT demonstrates the most utility.

Main Methods:

• Review of retrospective studies utilizing archival FFPE kidney transplant biopsies.
• Analysis of cross-organ applications and emerging implementation-oriented studies.

Main Results:

• B-HOT shows potential for refining diagnoses of antibody-mediated rejection (AMR), particularly in challenging Banff phenotypes.
• Evidence supports translatability across organs (heart, uterus) and in xenotransplantation.
• Emerging studies explore automated reporting and sparse classifiers.

Conclusions:

• Strongest evidence supports B-HOT's adjunctive role in classifying kidney rejection, especially AMR and threshold-limited cases.
• Routine implementation faces hurdles in standardization, harmonization, and heterogeneity.
• Prospective studies are required to assess B-HOT's impact on clinical management and graft outcomes.