Department of Pathology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States.
Department of Pathology, Medical University of Vienna, Vienna, Austria.
Transpl Int. 2023 Aug 23;36:11589. doi: 10.3389/ti.2023.11589. eCollection 2023.
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.
血栓性微血管病 Banff 工作组（TMA-BWG）成立于 2015 年，旨在调查当前的实践情况，并为肾移植血栓性微血管病（Tx-TMA）制定最低诊断标准（MDC）。为了在病理学家和肾脏病学家之间达成共识，TMA-BWG 设计了一个 3 期研究。本文介绍了该研究的第 1 阶段。该研究使用德尔菲法，23 名 panelists（均具有 >3 年的 Tx-TMA 病理诊断经验）列出了他们的 MDC，包括光镜、免疫荧光和电子显微镜病变、临床和实验室信息以及鉴别诊断。经过 9 轮（R）的共识，使用 37 例活检（28 例 TMA，9 例非 TMA）的全切片数字图像在线评估，验证了 MDC。从 338 项标准开始，该过程产生了 24 项标准和 8 项鉴别诊断，包括 18 项病理、2 项临床和 4 项实验室标准。结果表明，3/4 的 panelists 对 3/4 的病例诊断达成了共识。该过程还细化了 4 种光镜和 4 种电子显微镜病变的定义。在 Banff 分类中，首次使用德尔菲法达成共识。该研究表明，德尔菲法是一种民主且具有成本效益的方法，允许大量处理移植标准的医生之间快速达成共识。
