Rabant Marion, Adam Benjamin A, Aubert Olivier, Böhmig Georg A, Clahsen Van-Groningen Marian, Cornell Lynn D, de Vries Aiko P J, Huang Edmund, Kozakowski Nicolas, Perkowska-Ptasinska Agnieszka, Riella Leonardo V, Rosales Ivy A, Schinstock Carrie, Simmonds Naomi, Thaunat Olivier, Willicombe Michelle
Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.
Transplantation. 2025 Feb 1;109(2):292-299. doi: 10.1097/TP.0000000000005112. Epub 2024 Jun 18.
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.
2022年9月,第16届班夫会议在加拿大艾伯塔省班夫举行,此次会议恰逢班夫分类30周年,促成了最近两篇论文的发表。班夫会议的讨论重点是对整个班夫流程提出改进建议。与此一致的是,为病理学界和移植肾脏病学界的16名代表(肾脏移植领域的专家)提供了一次独特的机会,让他们审阅这两篇班夫手稿。目的是提供有见地的评论,评估提议的更改可能产生的任何潜在影响,并确定班夫分类中未来可能需要改进的潜在领域。该小组对将两个新实体,即“微血管炎症/损伤,供体特异性抗体阴性且C4d阴性”和“可能的抗体介导排斥反应”纳入第2类表示满意。这些变化扩展了分类,有助于涵盖更多活检病例,并为进一步探索这些病变的临床意义提供了机会。然而,我们发现班夫分类仍然复杂,这可能会阻碍其广泛应用,即便考虑到肾移植病理复杂的病理生理学,一定程度的复杂性可能不可避免。解决慢性活动性T细胞介导排斥反应(CA TCMR)的组织形态学诊断问题,可能重新考虑采用与第2类相同的诊断-诊断不明方法来诊断间质纤维化和肾小管萎缩中的炎症以及慢性活动性T细胞介导排斥反应,这也是一个重要目标。此外,我们认为在分子诊断能够常规整合之前,需要更多证据,并强调需要确定临床和组织学背景,并通过严格的临床试验证实其临床影响。最后,我们的讨论强调了在患者护理方面多学科决策的持续必要性。