Delphi: A Democratic and Cost-Effective Method of Consensus Generation in Transplantation
Transplant International, vol. 36, pp. 11589
Abstract
The Thrombotic Microangiopathy Banff Working Group (TMA-BWG) was formed in 2015 to survey current practices and develop minimum diagnostic criteria (MDC) for renal transplant TMA (Tx-TMA). To generate consensus among pathologists and nephrologists, the TMA BWG designed a 3-Phase study. Phase I of the study is presented here. Using the Delphi methodology, 23 panelists with >3 years of diagnostic experience with Tx-TMA pathology listed their MDC suggesting light, immunofluorescence, and electron microscopy lesions, clinical and laboratory information, and differential diagnoses. Nine rounds (R) of consensus resulted in MDC validated during two Rs using online evaluation of whole slide digital images of 37 biopsies (28 TMA, 9 non-TMA). Starting with 338 criteria the process resulted in 24 criteria and 8 differential diagnoses including 18 pathologic, 2 clinical, and 4 laboratory criteria. Results show that 3/4 of the panelists agreed on the diagnosis of 3/4 of cases. The process also allowed definition refinement for 4 light and 4 electron microscopy lesions. For the first time in Banff classification, the Delphi methodology was used to generate consensus. The study shows that Delphi is a democratic and cost-effective method allowing rapid consensus generation among numerous physicians dealing with large number of criteria in transplantation.
Authors 27
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Marjan Afrouzian corresponding
The University of Texas Medical Branch at Galveston
Affiliation as printed
Department of Pathology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
Department of Pathology, United States
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Affiliation as printed
Department of Pathology, Medical University of Vienna, Vienna, Austria
Department of Pathology, Austria
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Washington University in St. Louis · Ludwig-Maximilians-Universität München
Affiliation as printed
Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
GeoBio-Center, Ludwig Maximilian University of Munich, Munich, Germany
Department of Pathology and Immunology, United States
GeoBio-Center, Germany
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Sahlgrenska University Hospital
Affiliation as printed
Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Clinical Microbiology, Sweden
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Affiliation as printed
Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, United States
Department of Pathology and Genomic Medicine, United States
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University Health Network · Krembil Brain Institute
Affiliation as printed
Krembil Brain Institute, University Health Network (UHN), Toronto, ON, Canada
Krembil Brain Institute, Canada
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Affiliation as printed
Department of Pathology, Medical University of Vienna, Vienna, Austria
Department of Pathology, Austria
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Affiliation as printed
Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States
Department of Pathology and Laboratory Medicine, United States
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Affiliation as printed
Arkana Laboratories, Little Rock, AR, United States
Arkana Laboratories, United States
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Affiliation as printed
Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
Department of Pathology and Laboratory Medicine, United States
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Sorbonne Université · Assistance Publique – Hôpitaux de Paris · Hôpital Tenon
Affiliation as printed
Department of Pathology, Université de Sorbonne, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
Department of Pathology, France
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Affiliation as printed
New York Medical College, Valhalla, NY, United States
New York Medical College, United States
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Affiliation as printed
Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, United States
Department of Pathology and Immunology, United States
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Erasmus MC · Universitätsklinikum Aachen · Erasmus MC Transplant Institute · RWTH Aachen University
Affiliation as printed
Department of Pathology and Clinical Bioinformatics, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
Institute for Cell and Tumor Biology, University Hospital RWTH Aachen, Aachen, Germany
Department of Pathology and Clinical Bioinformatics, Netherlands
Institute for Cell and Tumor Biology, Germany
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Universidade Federal de Minas Gerais
Affiliation as printed
Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Departamento de Patologia Geral, Brazil
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Affiliation as printed
Department of Neurology, School of Medicine, Koç University, Istanbul, Türkiye
Department of Neurology, Türkiye
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NSW Health Pathology · University of Newcastle Australia
Affiliation as printed
Department of Anatomical Pathology, NSW Health Pathology, Callaghan, NSW, Australia
School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
Department of Anatomical Pathology, Australia
School of Medicine and Public Health, Australia
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Affiliation as printed
Department of Pathology, School of Medicine, University of Zagreb, Zagreb, Croatia
Department of Pathology, Croatia
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Affiliation as printed
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
Department of Laboratory Medicine and Pathology, United States
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Charles University · AeskuLab (Czechia)
Affiliation as printed
AeskuLab Pathology and Department of Pathology, Charles University, Prague, Czechia
AeskuLab Pathology and Department of Pathology, Czechia
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King Fahad Specialist Hospital
Affiliation as printed
Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
Department of Pathology and Laboratory Medicine, Saudi Arabia
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Affiliation as printed
Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
Department of Pathology, Türkiye
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Hôpital Necker-Enfants Malades · Université Paris Cité
Affiliation as printed
Department of Pathology, Necker-Enfants Malades Hospital, Université de Paris Cité, Paris, France
Department of Pathology, Necker-Enfants Malades Hospital, Université de Paris Cité, France
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Hôpital Maisonneuve-Rosemont · Université de Montréal
Affiliation as printed
Department of Pathology, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada
Department of Pathology, Canada
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The University of Texas Medical Branch at Galveston
Affiliation as printed
Department of Pathology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
Department of Pathology, United States
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Affiliation as printed
Kidney Pancreas Transplantation, Instituto de Nefrología-Nephrology, Buenos Aires, Argentina
Kidney Pancreas Transplantation, Argentina
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Isfahan University of Medical Sciences
Affiliation as printed
Department of Pathology, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Pathology, Iran
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