Pathological back-ground of renal transplant pathology and important mile-stones of the Banff classification

Transcription

1 Banff 1 Banff Pathological back-ground of renal transplant pathology and important mile-stones of the Banff classification Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital Morozumi Kunio, Takeda Asami Summary Standardization of renal allograft biopsy interpretation is necessary to guide therapy. This manuscript describes milestones of the Banff classification for renal allograft pathology developed by an international investigators conference. From small beginnings in 1991, the Banff working classification of renal allograft pathology has grown to be a major force for setting standards in renal transplant pathology. The meeting, classification, and consensus process have a unique history. Semiquantitative scorings of key lesions, such as tubulitis, interstitial inflammation, capillaritis, arteritis, and others, make a central core of the Banff scheme. The Banff classification proposed many new concepts related to pathogenesis of rejection. There are many important issues, including T-lymphocyte related rejaction, antibody-mediated rejection ABMR, chronic active rejection, and C4d negative antibody -mediated rejection. ABMR is associated with heterogeneous phenotypes even within the same type of transplant. The willingness of the Banff process to continually adapt in response to new research and to improve potential weaknesses led to the implementation of six working groups in the following areas: isolated v- lesion, fibrosis scoring, glomerular lesions, molecular pathology, polyomavirus nephropathy, and quality assurance. Furthermore, compelling molecular research data led to the discussion of incorporation of omics technologies and the discovery of new tissue markers with the goal of soon combining histopathology and molecular parameters within the Banff working classification. renal transplant pathology, Banff classification, pathogenesis of rejection 1 3

2 2 Vol. 49, No MP azathioprine 1978 cyclosporin T Cyclosporin Azathioprine cyclosporin cyclosporin 1980 cyclosporin cyclosporin MMF CD25 baziliximab BK-polyoma HLA 1980 HLA HLA HLA donor specific antibody DSA non-specific antibody de novo DSA C4d ABO T HLA C4d non-hla gene-tip Banff Banff 1980 Kim Solez 1991 Banff Banff Banff Banff Banff Banff Banff Banff report Banff

3 Banff 3 Banff Banff CAN Banff i t gv T Banff 1997 chronic/sclerosing allograft nephropathy CAN Banff 1997 b CAN T Banff Banff Banff Banff Banff Banff 4 PTC C4d a b PTC c Banff TMR ABMR 2005 Banff 5 T CAN T CAN interstitial fibrosis and tubular atrophy IF/TA PTC ptc t2 t Banff 2005 Banff antibody-mediated changes active rejection C4d ABO ABO C4d C4d IF IHC Banff 2009 Banff 6 7

4 4 Vol. 49, No C4d C4d C4d / T g0 cg0 ptc0 PTC 5 C4d I II ptc/g 0 and/or III v3 C4d C4d and/or PTC and/or / and/or 3 Borderline Changes T t1 t2 or t3 with i0 or i1 i2 i3 t1 4 T T IA 25% i2 i3 t2 IB 25% i2 i3t3 IIA v1 IIB 25% v2 III v3 T Chronic allograft arteriopathy 5 IF/TA I 25% II 26 50% III 50% 6 g cg cv Banff Working Group Banff 2005 Banff

5 Banff 5 omics technology Banff 1 mrna microarray T B gene-tip gene-tip gene-tip graft biopsy molecular parameter 2007 Banff working group Isolated v-lesion fibrosis scoring glomerular lesion quality assurance polyoma virus nephropathy molecular pathology C4d-negative AMR implantation biopsy working group Banff Banff Banff Banff Banff 1 Solez K, Axelsen RA, Benediktsson H, et al. International standardization of criteria for the histologic diagnosis of renal allograft rejection: the Banff working classification of kidney transplant pathology. Kidney Int 1993; 44: Racusen LC, Solez K, Colvin RB, et al. The Banff 97 working classification of renal allograft pathology. Kidney Int 1999; 55: Racusen LC, Colvin RB, Solez K, et al. Antibodymediated rejection criteria-an addition to the Banff 97 classification of renal allograft rejection. Am J Transplant 2003; 3: Racusen LC, Halloran PF, Solez K. Banff 2003 meeting report: new diagnostic insights and standards. Am J Transplant 2004; 4: Solez K, Colvin RB, Racusen LC, et al.banff 05 Meeting Report: differential diagnosis of chronic allograft injury and elimination of chronic allograft nephropathy CAN. Am J Transplant 2007; 7: SisB,MengelM,HaasM,et al. Banff 09 meeting report: antibody mediated graft deterioration and implementation of Banff working groups. Am J Transplant 2010; 10: :.,.. :, 2010: