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The Banff Cl assification: Slide Seminar

The Banff Cl assification: Slide Seminar. Kim Solez, M.D. The Banff Schema was first developed by a group of pathologists, nephrologists, and transplant surgeons at a meeting in Banff Canada August 2-4, 1991. The Banff Schema was first developed by a

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The Banff Cl assification: Slide Seminar

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  1. The Banff Classification:Slide Seminar Kim Solez, M.D.

  2. The Banff Schema was first developed by a group of pathologists, nephrologists, and transplant surgeons at a meeting in Banff Canada August 2-4, 1991. The Banff Schema was first developed by a group of pathologists, nephrologists, and transplant surgeons at a meeting in Banff Canada August 2-4, 1991. It has continued to evolve through meetings every two years and has become the worldwide standard for interpretation of transplant biopsies.

  3. Banff Classification: Milestones • 1991 First Conference • 1993 First Kidney International publication • 1995 Integration with CADI - identical scoring • 1997 Integration with CCTT classification • 1999 Second KI paper. Clinical practice guidelines. Implantation biopsies, microwave. • 2001 Classification of antibody-mediated rejection • Regulatory agencies participating

  4. Quantitative Criteria for Arteriolar Hyaline Thickening 0 = No PAS-positive hyaline thickening 1 = Mild-to-moderate PAS-positive hyaline thickening in at least one arteriole 2 = Moderate-to-severe PAS-positive hyaline thickening in more than one arteriole 3 = Severe PAS-positive hyaline thickening in many arterioles

  5. Changes not considered to be due to rejection • Post-transplant lymphoproliferative disorder • Non-specific changes • focal interstitial inflammation without tubulitis: Nodular infiltrates, perivascular infiltrates • vascular changes: endothelial reactive changes, vacuolization, venulitis. • Acute Tubular Injury • Acute Interstitial Nephritis • Cyclosporine-associated changes, acute or chronic • Subcapsular Injury • Pre-transplant Acute Endothelial Injury • Papillary Necrosis • De novo Glomerulonephritis • Recurrent Disease • Pre-existing Disease • Other-viral infection (CMV), obstruction and reflux

  6. Specimen Adequacy – (Banff ’97) Minimum Sampling • Unsatisfactory – No glomeruli or arteries • Marginal – 7 glomeruli with an artery • Adequate – 10 or more glomeruli with at least two arteries • Minimum Sampling: 7 slides – 3 H&E, 3 PAS or silver stains, and 1 trichrome

  7. Standardization of tx biopsy interpretation. Banff Classification • Classification begun at 1991 • Banff meeting has become the worldwide standard • Consensus process has now extended to all solid organs • Meetings continue every two years. Next meeting in Edmonton in summer of 2005 • Future meetings planned every two years through 2009 • Standardization principles now being extended from biopsy reporting to tissue typing, imaging, all the other elements in transplant care

  8. Standardization of tx biopsy interpretation. Banff Classification • Lesion quantitation • Reproducibility and clinical validation studies • Involvement of pathologists, clinicians, surgeons, scientists, registries, and regulatory agencies in consensus generation • Meetings have large amount of unstructured time for deliberation and consensus generation • Most content online at: http://cnserver0.nkf.med.ualberta.ca/Banff • Linked from http://www.cybernephrology.org

  9. Agreed upon clinical practice guidelines that need buy-in generally • Implantation biopsies • Rapid paraffin (microwave) processing for rapid reading rather than frozen sections • Routine (“protocol”) biopsies • H&E, PAS (+/o silver), and trichrome or Sirius red stains

  10. Perioperative (implantation) Biopsy • Core vs wedge • Adequacy of sample • Preimplantation vs. postimplantation • Consensus: • Perioperative biopsy (? core, ? wedge) is sufficiently safe to be recommended for any reasonable defined objective STANDARD OF CARE!

  11. Protocol (routine) biopsies • Early and intermediate post-transplant protocol biopsies • Consensus: • Generally done under ultrasound guidance • Have very low morbidity • Safe enough to be requested of consenting patients for research purposes when the objectives are clearly formulated and stated STANDARD OF SCIENCE!

  12. Future Banff Meetings: • 2005 - Edmonton, Alberta, Canada • 2007 - Edinburgh, Scotland • 2009 - Banff, Alberta, Canada

  13. Close • Banff ’97 Classification is the new universal classification of kidney transplant pathology • Future improvements involve participation in Banff meetings via physical presence or contributions via Internet

  14. Subscribe to free Nephrol Email group:Become part of the ongoing discussions To subscribe: send an E-mail message to majordomo@ualberta.ca with the message “subscribe Nephrol” (or Nephrol-digest) Or contact Kim.Solez@UAlberta.ca or Michele.Hales@UAlberta.ca

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