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.
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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.
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Chronic active rejection diagnosis and interpretation of active versus chronic changes continues to be an issue with pathologists and some non-pathologists. This section of the manuscripot will need to be clarified significantly.
Comment from H. Mesa
Regarding the examples for reporting chronic active TCMR.
Example 1: No evidence of active TCMR. Ca TCMR (stage 1) consisting of chronic transplant arteriopathy and focal lobular changes; overall inactive inflammation
I still find this confusing and contradictory: Ca (chronic active) TCMR overall inactive? It’s hard to understand the concept of chronic active, overall inactive. Is this really what you’re trying to say?