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The Banff ClThe Banff Classification:assification: Slide SeminarSlide Seminar
Kim Solez, M.D.Kim Solez, M.D.
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The Banff Schema was first developed by a The Banff Schema was first developed by a group of pathologists, nephrologists, and group of pathologists, nephrologists, and transplant surgeons at a meeting in Banff Canada transplant surgeons at a meeting in Banff Canada August 2-4, 1991.August 2-4, 1991.
The Banff Schema was first developed by a The Banff Schema was first developed by a group of pathologists, nephrologists, and group of pathologists, nephrologists, and transplant surgeons at a meeting in Banff Canada transplant surgeons at a meeting in Banff Canada August 2-4, 1991.August 2-4, 1991.
The Banff Schema was first developed by a The Banff Schema was first developed by a group of pathologists, nephrologists, and group of pathologists, nephrologists, and transplant surgeons at a meeting in Banff Canada transplant surgeons at a meeting in Banff Canada August 2-4, 1991.August 2-4, 1991.
The Banff Schema was first developed by a The Banff Schema was first developed by a group of pathologists, nephrologists, and group of pathologists, nephrologists, and transplant surgeons at a meeting in Banff Canada transplant surgeons at a meeting in Banff Canada August 2-4, 1991.August 2-4, 1991.
It has continued to evolve through It has continued to evolve through meetings every two years and has meetings every two years and has become the worldwide standard for become the worldwide standard for interpretation of transplant biopsies.interpretation of transplant biopsies.
It has continued to evolve through It has continued to evolve through meetings every two years and has meetings every two years and has become the worldwide standard for become the worldwide standard for interpretation of transplant biopsies.interpretation of transplant biopsies.
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Banff Classification: Milestones Banff Classification: Milestones
1991 First Conference1991 First Conference
1993 First Kidney International publication1993 First Kidney International publication
1995 Integration with CADI - identical scoring1995 Integration with CADI - identical scoring
1997 Integration with CCTT classification1997 Integration with CCTT classification
1999 Second KI paper. Clinical practice guidelines. 1999 Second KI paper. Clinical practice guidelines. Implantation biopsies, microwave.Implantation biopsies, microwave.
2001 Classification of antibody-mediated rejection2001 Classification of antibody-mediated rejection
Regulatory agencies participatingRegulatory agencies participating
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Quantitative Criteria for Arteriolar Quantitative Criteria for Arteriolar Hyaline ThickeningHyaline Thickening
0 = No PAS-positive hyaline thickening0 = No PAS-positive hyaline thickening
1 = Mild-to-moderate PAS-positive hyaline thickening 1 = Mild-to-moderate PAS-positive hyaline thickening in at least one arteriolein at least one arteriole
2 = Moderate-to-severe PAS-positive hyaline thickening 2 = Moderate-to-severe PAS-positive hyaline thickening in more than one arteriolein more than one arteriole
3 = Severe PAS-positive hyaline thickening in many 3 = Severe PAS-positive hyaline thickening in many arteriolesarterioles
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Changes Changes notnot considered to be due to considered to be due to rejectionrejection Post-transplant lymphoproliferative disorderPost-transplant lymphoproliferative disorder
Non-specific changesNon-specific changes
focal interstitial inflammation without tubulitis: Nodular infiltrates, focal interstitial inflammation without tubulitis: Nodular infiltrates, perivascular infiltratesperivascular infiltrates
vascular changes: endothelial reactive changes, vacuolization, vascular changes: endothelial reactive changes, vacuolization, venulitisvenulitis. .
Acute Tubular InjuryAcute Tubular Injury
Acute Interstitial NephritisAcute Interstitial Nephritis
Cyclosporine-associated changes, acute or chronicCyclosporine-associated changes, acute or chronic
Subcapsular InjurySubcapsular Injury
Pre-transplant Acute Endothelial InjuryPre-transplant Acute Endothelial Injury
Papillary NecrosisPapillary Necrosis
De novo GlomerulonephritisDe novo Glomerulonephritis
Recurrent DiseaseRecurrent Disease
Pre-existing DiseasePre-existing Disease
Other-viral infection (CMV), obstruction and refluxOther-viral infection (CMV), obstruction and reflux
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Specimen Adequacy – (Banff ’97) Specimen Adequacy – (Banff ’97) Minimum SamplingMinimum Sampling
Unsatisfactory – No glomeruli or arteriesUnsatisfactory – No glomeruli or arteries
Marginal – 7 glomeruli with an arteryMarginal – 7 glomeruli with an artery
Adequate – 10 or more glomeruli with at least two Adequate – 10 or more glomeruli with at least two arteriesarteries
Minimum Sampling: 7 slides – 3 H&E, 3 PAS or Minimum Sampling: 7 slides – 3 H&E, 3 PAS or silver stains, and 1 trichromesilver stains, and 1 trichrome
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Standardization of tx biopsy Standardization of tx biopsy interpretation. Banff Classificationinterpretation. Banff Classification
Classification begun at 1991 Classification begun at 1991
Banff meeting has become the worldwide standardBanff meeting has become the worldwide standard
Consensus process has now extended to all solid organs Consensus process has now extended to all solid organs
Meetings continue every two years. Next meeting in Meetings continue every two years. Next meeting in Edmonton in summer of 2005Edmonton in summer of 2005
Future meetings planned every two years through 2009Future meetings planned every two years through 2009
Standardization principles now being extended from biopsy Standardization principles now being extended from biopsy reporting to tissue typing, imaging, all the other elements in reporting to tissue typing, imaging, all the other elements in transplant caretransplant care
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Standardization of tx biopsy Standardization of tx biopsy interpretation. Banff Classificationinterpretation. Banff Classification Lesion quantitationLesion quantitation
Reproducibility and clinical validation studiesReproducibility and clinical validation studies
Involvement of pathologists, clinicians, surgeons, Involvement of pathologists, clinicians, surgeons, scientists, registries, and regulatory agencies in scientists, registries, and regulatory agencies in consensus generationconsensus generation
Meetings have large amount of unstructured time for Meetings have large amount of unstructured time for deliberation and consensus generationdeliberation and consensus generation
Most content online at: Most content online at: http://cnserver0.http://cnserver0.nkfnkf.med..med.ualbertaualberta.ca/Banff.ca/Banff
Linked from http://www.cybernephrology.orgLinked from http://www.cybernephrology.org
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Agreed upon clinical practice Agreed upon clinical practice guidelines that need buy-in generallyguidelines that need buy-in generally
Implantation biopsiesImplantation biopsies
Rapid paraffin (microwave) processing for rapid Rapid paraffin (microwave) processing for rapid reading rather than frozen sectionsreading rather than frozen sections
Routine (“protocol”) biopsiesRoutine (“protocol”) biopsies
H&E, PAS (+/o silver), and trichrome or Sirius red H&E, PAS (+/o silver), and trichrome or Sirius red stainsstains
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Perioperative (implantation) BiopsyPerioperative (implantation) Biopsy
Core vs wedgeCore vs wedge
Adequacy of sampleAdequacy of sample
Preimplantation vs. postimplantationPreimplantation vs. postimplantation
Consensus: Consensus:
Perioperative biopsy (? core, ? wedge) is Perioperative biopsy (? core, ? wedge) is sufficiently safe to be recommended for any sufficiently safe to be recommended for any reasonable defined objectivereasonable defined objective
STANDARD OF CARE!STANDARD OF CARE!
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Protocol (routine) biopsiesProtocol (routine) biopsies
Early and intermediate post-transplant protocol biopsiesEarly and intermediate post-transplant protocol biopsies
Consensus: Consensus:
Generally done under ultrasound guidanceGenerally done under ultrasound guidance
Have very low morbidityHave very low morbidity
Safe enough to be requested of consenting patients for Safe enough to be requested of consenting patients for research purposes when the objectives are clearly research purposes when the objectives are clearly formulated and statedformulated and stated
STANDARD OF SCIENCE!STANDARD OF SCIENCE!
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Future Banff Meetings:Future Banff Meetings:
2005 - Edmonton, Alberta, Canada2005 - Edmonton, Alberta, Canada
2007 - Edinburgh, Scotland2007 - Edinburgh, Scotland
2009 - Banff, Alberta, Canada2009 - Banff, Alberta, Canada
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CloseClose
Banff ’97 Classification is the new universal Banff ’97 Classification is the new universal classification of kidney transplant pathologyclassification of kidney transplant pathology
Future improvements involve participation in Future improvements involve participation in Banff meetings via physical presence or Banff meetings via physical presence or contributions via Internetcontributions via Internet
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Subscribe to free Nephrol Email group:Subscribe to free Nephrol Email group:Become part of the ongoing discussionsBecome part of the ongoing discussions
To subscribe: send an E-mail message to To subscribe: send an E-mail message to [email protected] with the message [email protected] with the message
“subscribe Nephrol” “subscribe Nephrol” (or Nephrol-digest)(or Nephrol-digest)
Or contact [email protected] or Or contact [email protected] or [email protected]@UAlberta.ca
