AJT-Banff Blog

2024 Banff Meeting: Vascularized Composite Allotransplantation (VCA) Report Linda C. Cendales et al Full manuscript coming soon to SSRN Abstract The last Banff VCA classification revision was published in AJT in 2024. The Banff 2024 meeting resulted in no changes to the Banff VCA Classification.   The VCA session focused on different topics on VCA, on uterus transplantation, and a discussion on next steps. An update from the International Registry on Hand and Composite Tissue Transplantation was presented showing an overall good functional recovery in upper extremity transplants and good functional and aesthetic outcomes in face transplants, with similar complications to solid organ transplants. A summary on VCA, regenerative medicine, and xenotransplantation ethical considerations and controversies was presented. Applications of regenerative medicine in VCA and other numerous prospects for the future were covered including examples of the potential role of AI in these applications. A presentation on the optimization of a transplant biopsy molecular profiling pipeline to explore site-specific transcriptomic changes during VCA rejection, with an expansion to single cell resolution was presented by the primary group doing these studies. A review of the detection of donor specific antibody in situ in solid organ transplantation was presented pointing out considerations for VCA. The presence of intra-graft antibodies and their association with outcomes was discussed. Two talks on uterus transplantation took place. One presentation focused on the reproducibility of rejection based on a multicenter study showing also data on differential gene expression of different rejection grades. On a separate presentation the natural progression of rejection in uterus transplantation as illustrated through serial cervical biopsies in patients with a delayed hysterectomy in the absence of immunosuppression was shown. The group discussion included further refinements to the Banff VCA classification system, the timing for a Banff uterus transplantation scoring system, and a discussion of collaborations on different studies.    Following the discussion, this survey was generated: https://duke.qualtrics.com/jfe/form/SV_8B16b8QZvriO7gq We look forward to your participation in the survey and your input into the VCA classification refinement.  Join the conversation by providing your comment(s) on the: • Clinical feasibility and utility of the classification • Areas of improvement for clarity and reduction of ambiguity • Inaccuracies and inconsistency • Evidence and knowledge gaps The comment period will be open until August 31, 2025.  All comments will be reviewed and considered by the Banff meeting report author groups prior to finalizing the manuscripts and submission for formal peer review. How to comment: Click on the comment box and you will be prompted to create an account Once your account is created, you will return to the article, please enter your comment and click publish Make sure to follow the post for updates on new comments and replies

Banff 2024 Pancreas Transplantation Report: Diagnosis and Impact of Chronic Active T-Cell Mediated Allograft Rejection, Re-Evaluation of the Indeterminate Category and Utilization of CD3/CD68 Immunostains in Biopsies with Ambiguous Findings Maike Buettner et al Read the full manuscript on the SSRN site Abstract The 2022 meeting report, provided more specific criteria for T-cell mediated (TCMR) and antibody mediated rejection (AbMR). Criteria for chronic active (ca) rejection and discussions on the potential value of lymphoid immunostains, were also introduced.  The latter topics were central in the pancreas session in the 2024 Banff conference held in Paris (France), and in subsequent consensus discussions.  In this report, criteria for caTCMR where confirmed, but the requirement of underlying stage 1 fibrosis (≥30% of core) was removed to allow for earlier diagnosis.  The criteria initially proposed for caAbMR remain unchanged.   Ca rejection is associated with increased risk of graft loss and often occurs in patients with repeated or untreated rejection.  Criteria defining the indeterminate (IND) category were expanded to include lobular changes below rejection thresholds.  Understanding common clinical scenarios coinciding with IND biopsies, allows for more refined etiological diagnosis and better therapeutic options. Systematic evaluation of CD3 and CD68 immunostains contributed to more accurate diagnoses and was essential in 9.5% of cases, facilitated the diagnosis in 49% of cases and helped rule out TCMR in 80% IND biopsies. The working group expects that the current recommendations and refinements can enhance the applicability and reproducibility of the pancreas schema. Join the conversation by providing your comment(s) on the: • Clinical feasibility and utility of the classification • Areas of improvement for clarity and reduction of ambiguity • Inaccuracies and inconsistency • Evidence and knowledge gaps The comment period will be open until August 31, 2025.  All comments will be reviewed and considered by the Banff meeting report author groups prior to finalizing the manuscripts and submission for formal peer review. How to comment: Click on the comment box and you will be prompted to create an account Once your account is created, you will return to the article, please enter your comment and click publish Make sure to follow the post for updates on new comments and replies

XVIIth BANFF conference on Allograft pathology the BANFF workshop heart report: microvascular inflammatory burden in Heart Transplantation and the impact of non-invasive diagnostic tools. M. Fedrigo et al Full manuscript coming soon to SSRN Abstract The Banff-PITOR joint meeting on Allograft Pathology was held in 2024 in Paris. According to the BANFF policy, heart transplant group discussed two main topics: (a) the microvascular inflammatory burden on endomyocardial biopsy (EMB) exploring new advancements on inflammation-endothelium interactions within the complexity of inflammatory pathways on allograft, and (b) the impact of molecular non-invasive tools in the rejection monitoring. The goal was to discuss the impact of molecular pathology performed on paraffin-embedded tissue in the context of inflammatory burden on EMBs, to explore the new face of endothelium in the microvasculature and its relationship with alloantibodies. The introduction of tissue and blood molecular analysis enhanced the reliability and accuracy of EMBs interpretation by pathologists and also emphasized the complexity of the inflammatory mechanisms occurring in the allograft. The excellent negative predictive value of non-invasive biomarkers and the new imaging modalities foresee the applicability in the clinical practice and potentially changing the follow up of the heart transplanted patients. Join the conversation by providing your comment(s) on the: • Clinical feasibility and utility of the classification • Areas of improvement for clarity and reduction of ambiguity • Inaccuracies and inconsistency • Evidence and knowledge gaps The comment period will be open until August 31, 2025.  All comments will be reviewed and considered by the Banff meeting report author groups prior to finalizing the manuscripts and submission for formal peer review. How to comment: Click on the comment box and you will be prompted to create an account Once your account is created, you will return to the article, please enter your comment and click publish Make sure to follow the post for updates on new comments and replies