Banff Classification for Kidney Transplant Rejection
Translate kidney allograft biopsy lesion scores into a Banff rejection category (antibody-mediated rejection, T-cell-mediated rejection, borderline changes, and chronic lesions) so nephrologist and pathologist agree on one diagnosis.
When to use it
Use when interpreting a kidney transplant biopsy to assign a Banff category, communicate findings consistently across the transplant team, and guide anti-rejection therapy.
Category
Transplantation
References
- Loupy A et al. The Banff 2019 Kidney Meeting Report (I): Updates on and clarification of criteria for T cell- and antibody-mediated rejection. Am J Transplant. 2020;20:2318-2331. PMID: 32463180
- Haas M et al. The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials. Am J Transplant. 2018;18:293-307. PMID: 29243394
- Current Reference Guide to the Banff Classification — Banff Foundation for Allograft Pathology. Banff-Kidney-2024-3; updated April 20, 2026
Common clinical questions
- What is the difference between borderline changes and TCMR on Banff?
- Borderline changes show tubulitis with minor or no interstitial inflammation that falls short of the threshold for T-cell-mediated rejection. Whether to treat borderline changes depends on graft function, donor-specific antibodies, and dd-cfDNA; established TCMR meets the interstitial-inflammation and tubulitis thresholds and is treated with corticosteroids.
About NephroMind
This calculator is part of NephroMind, a free clinical decision-aid platform from the Arab Society of Nephrology and Renal Transplantation (ASNRT) — over 128 bedside nephrology calculators plus a renal drug-dosing database, coded by a practicing transplant nephrologist.