Clinical Investigation

Kidney International (1993) 44, 411–421; doi:10.1038/ki.1993.259

International standardization of criteria for the histologic diagnosis of renal allograft rejection: The Banff working classification of kidney transplant pathology

Kim Solez1, Roy A Axelsen2, Hallgrimur Benediktsson3, James F Burdick4, Arthur H Cohen5, Robert B Colvin6, Byron P Croker7, Dominique Droz8, Michael S Dunnill9, Philip F Halloran1, Pekka Häyry10, J Charles Jennette11, Paul A Keown12, Niels Marcussen13, Michael J Mihatsch14, Kunio Morozumi15, Bryan D Myers16, Cynthia C Nast5, Steen Olsen13, Lorraine C Racusen4, Eleanor L Ramos7, Seymour Rosen6, David H Sachs17, Daniel R Salomon18, Fred Sanfilippo4, Regina Verani19, Eeva von Willebrand10 and Yutaka Yamaguchi20,1

  1. 1Edmonton
  2. 2Brisbane
  3. 3Calgary
  4. 4Baltimore
  5. 5Los Angeles
  6. 6Boston
  7. 7Gainesville
  8. 8Paris
  9. 9Oxford
  10. 10Helsinki
  11. 11Chapel Hill
  12. 12Vancouver
  13. 13Aarhus
  14. 14Basel
  15. 15Nagoya
  16. 16Stanford
  17. 17Charlestown
  18. 18Bethesda
  19. 19Houston
  20. 20Tokyo

Correspondence: Dr Kim Solez, Department of Laboratory Medicine and Pathology, University of Alberta, 5B4.02 Walter Mackenzie Centre, Edmonton, Alberta, Canada T6G 2R7.

1All authors made an intellectual contribution to the writing of this paper. The blinded reviews of panel slides for assessment of reproducibility were conducted by Drs. Benediktsson, Jennette, Marcussen, Olsen, Racusen, and Solez.

Received 1 September 1992; Revised 8 February 1993; Accepted 10 March 1993.

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Abstract

International standardization of criteria for the histologic diagnosis of renal allograft rejection: The Banff working classification of kidney transplant pathology. A group of renal pathologists, nephrologists, and transplant surgeons met in Banff, Canada on August 2–4, 1991 to develop a schema for international standardization of nomenclature and criteria for the histologic diagnosis of renal allograft rejection. Development continued after the meeting and the schema was validated by the circulation of sets of slides for scoring by participant pathologists. In this schema intimal arteritis and tubulitis are the principal lesions indicative of acute rejection. Glomerular, interstitial, tubular, and vascular lesions of acute rejection and "chronic rejection" are defined and scored 0 to 3+, to produce an acute and/or chronic numerical coding for each biopsy. Arteriolar hyalinosis (an indication of cyclosporine toxicity) is also scored. Principal diagnostic categories, which can be used with or without the quantitative coding, are: (1) normal, (2) hyperacute rejection, (3) borderline changes, (4) acute rejection (grade I to III), (5) chronic allograft nephropathy ("chronic rejection") (grade I to III), and (6) other. The goal is to devise a schema in which a given biopsy grading would imply a prognosis for a therapeutic response or long-term function. While the clinical implications must be proven through further studies, the development of a standardized schema is a critical first step. This standardized classification should promote international uniformity in reporting of renal allograft pathology, facilitate the performance of multicenter trials of new therapies in renal transplantation, and ultimately lead to improvement in the management and care of renal transplant recipients.

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