Maarten Naesens et al
Read the full manuscript on SSRN
Abstract
The XVI-th Banff Meeting for Allograft Pathology was held in Banff, Alberta, Canada, from 19th-23rd September 2022, as a joint meeting with the Canadian Society of Transplantation. To mark the 30th anniversary of the first Banff Classification, pre-meeting discussions were held on the past, present, and future of the Banff Classification. This report is a summary of the meeting highlights that were most important in terms of their effect on the Classification - discussions around microvascular inflammation and biopsy-based transcript analysis for diagnosis. In a post-meeting survey, international consensus was reached on these topics, and culminated in the delineation of new entities: "Probable antibody-mediated rejection (AMR)" and "Microvascular inflammation (MVI), DSA-negative and C4d-negative". Although biopsy-based transcript diagnostics are considered promising and remain an integral part of the Banff Classification (limited to diagnosis of AMR), more work needs to be done to agree on the exact classifiers, thresholds, and clinical context of use.
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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 June 30, 2023. 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.
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I have read with great interest the Banff 2022 reports. Congratulations and thanks to all the Banff team for their work! I wanted to take advantage of the offer to give my opinion as a clinician user.
- it is not clear to me if the 3 classical criteria will still be use (evidence of tissue injury, evidence of Ab interaction...) as they appear in the text but not in the table. Do you think we should avoid these definitions of criteria following this Banff update? If not, it may be of interest to include these terms in the table?
- The table 3 might be difficult to apprehend at the first glance. However, I think it removes doubts about certain elements.
I am wondering if reading difficulties could be linked to graphical details. For example the bold and underlined typeface: in the first column it refers to the criteria and in the second to the diagnosis, which appear above the the criteria DSA/C4d.
I have several thoughts that could perhaps improve readability:
- in the histomolecular description column, "MVI at or above threshold" appears as a title but this does not match with the molecular option. In the square bellow, "MVI below threshold" appears but bellow is detailed the first criteria. There is also the mention that molecular transcript may be used, which may be redundant with the "AND/OR molecular transcripts" in the square above. To improve readability, maybe the text could be limited to the criterion the user has to search?
- first column, second square: histological active or chronic criteria appear bellow "MVI below threshold" but it is not really specific to this square and if the user follows the table, after the very first line of the table, we are already in a situation where these criteria are met. Maybe the detail definition of these lesion (e.g "g > 0 in the absence of GN") could appear in the footnotes? Also, to have a step-by-step thinking, these data could be placed in the last column where the classification between active/chronic active/chronic inactive appears?
- in the second column, first line of each square is the diagnosis, then criteria are listed. In the spirit of step-by-step approach evoked by the arrows in the column headings, maybe it would be easier to read with a distinct column "C4d and DSA" yes/no, then a third column with the diagnosis?