Banff 2022 Kidney Commentary: Reflections and Future Directions

Transplantation, vol. 109, pp. 292–299

Abstract

In September 2022, in Banff, Alberta, Canada, the XVIth Banff meeting, corresponding to the 30th anniversary of the Banff classification, was held, leading to 2 recent publications. Discussions at the Banff meeting focused on proposing improvements to the Banff process as a whole. In line with this, a unique opportunity was offered to a selected group of 16 representatives from the pathology and transplant nephrology community, experts in the field of kidney transplantation, to review these 2 Banff manuscripts. The aim was to provide an insightful commentary, to gauge any prospective influence the proposed changes may have, and to identify any potential areas for future enhancement within the Banff classification. The group expressed its satisfaction with the incorporation of 2 new entities, namely "microvascular inflammation/injury donor-specific antibodies-negative and C4d negative" and "probable antibody-mediated rejection," into category 2. These changes expand the classification, facilitating the capture of more biopsies and providing an opportunity to explore the clinical implications of these lesions further. However, we found that the Banff classification remains complex, potentially hindering its widespread utilization, even if a degree of complexity may be unavoidable given the intricate pathophysiology of kidney allograft pathology. Addressing the histomorphologic diagnosis of chronic active T cell-mediated rejection (CA TCMR), potentially reconsidering a diagnostic-agnostic approach, as for category 2, to inflammation in interstitial fibrosis and tubular atrophy and chronic active T cell-mediated rejection was also an important objective. Furthermore, we felt a need for more evidence before molecular diagnostics could be routinely integrated and emphasized the need for clinical and histologic context determination and the substantiation of its clinical impact through rigorous clinical trials. Finally, our discussions stressed the ongoing necessity for multidisciplinary decision-making regarding patient care.

Authors 15

1. Marion Rabant corresponding

   Hôpital Necker-Enfants Malades · Assistance Publique – Hôpitaux de Paris

   Affiliation as printed

   Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

2. Benjamin Adam

   University of Alberta

   Affiliation as printed

   Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada

3. Georg A. Böhmig

   Medical University of Vienna

   Affiliation as printed

   Department of Medicine III, Medical University of Vienna, Vienna, Austria

4. Marian C. Clahsen‐van Groningen Aachen Institute of Experimental Medicine and Systems Biology

   Erasmus MC Transplant Institute · RWTH Aachen University

   Affiliation as printed

   Department of Pathology and Clinical Bioinformatics, Erasmus MC Transplant Institute, Rotterdam, the Netherlands

   Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, Aachen, Germany

   February 2024. Revision received 4 May 2024

5. Lynn D. Cornell

   Mayo Clinic

   Affiliation as printed

   Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN

6. Aiko P. J. de Vries Aachen Division of Nephrology Department of Medicine, Leiden University Medical Center Leiden Transplant Center

   Leiden University Medical Center

   Affiliation as printed

   Division of Nephrology, Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands

   Leiden Transplant Center, Leiden University Medical Center, Leiden, the Netherlands

   May 2024

7. Edmund Huang

   Cedars-Sinai Medical Center

   Affiliation as printed

   Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA

8. Nicolas Kozakowski

   Medical University of Vienna

   Affiliation as printed

   Department of Pathology, Medical University of Vienna, Vienna, Austria

9. Agnieszka Perkowska‐Ptasińska

   Medical University of Warsaw

   Affiliation as printed

   Department of Pathology, Medical University of Warsaw, Warsaw, Poland

10. Leonardo V. Riella

    Harvard University · Massachusetts General Hospital

    Affiliation as printed

    Nephrology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

11. Ivy A. Rosales

    Harvard University · Massachusetts General Hospital

    Affiliation as printed

    Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA

12. Carrie Schinstock

    Mayo Clinic

    Affiliation as printed

    Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN

13. Naomi Simmonds

    Guy's and St Thomas' NHS Foundation Trust

    Affiliation as printed

    Department of Pathology, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom

    Department of Pathology, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom

14. Olivier Thaunat

    Hospices Civils de Lyon · Hôpital Edouard Herriot

    Affiliation as printed

    Department of Transplantation, Nephrology and Clinical Immunology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France

15. Michelle Kay Willicombe

    Imperial College Healthcare NHS Trust · Hammersmith Hospital

    Affiliation as printed

    Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom