Banff 2022/2024 Rejection Pathway (Diagnosis, Timing, Treatment)
Work through the Banff 2022/2024 diagnostic pathway for a kidney allograft: combine biopsy lesion scores, DSA status, and donor-derived cell-free DNA to reach one rejection diagnosis and a treatment plan the whole transplant team agrees on.
When to use it
Use when a transplant biopsy or a rising creatinine raises the question of rejection. The pathway separates active antibody-mediated rejection, T-cell-mediated rejection, borderline changes, and chronic scarring, and flags when dd-cfDNA above 1 percent supports an active process.
Category
Transplantation. Related searches: banff pathway, banff 2022 classification, transplant rejection diagnosis, tcmr treatment, dd-cfdna transplant.
References
Loupy A et al. The Banff 2019 Kidney Meeting Report. Am J Transplant. 2020;20(9):2305-2331
Naesens M et al. The Banff 2022 Kidney Meeting Report. Am J Transplant. 2024;24(4):557-570
Common clinical questions
A transplant biopsy shows t2 i2 with IFTA 40 percent — how do I classify and treat it? t2 i2 with no intimal arteritis meets Banff Grade IA T-cell-mediated rejection (Grade IB requires severe tubulitis, t3). Treat active TCMR with pulse corticosteroids, adding anti-thymocyte globulin for steroid-resistant or vascular rejection. IFTA of 40 percent is established chronic scarring that will not reverse, so optimise maintenance immunosuppression and adherence rather than escalating therapy for the scar itself.
When does dd-cfDNA change Banff decision-making? Donor-derived cell-free DNA above roughly 1 percent supports an active rejection process and is most useful when the biopsy is borderline or when clinical suspicion is high but a biopsy is delayed. A low dd-cfDNA makes active rejection less likely but does not exclude it.
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 125 bedside nephrology calculators plus a renal drug-dosing database, coded by a practicing transplant nephrologist.