The Banff 2022 Kidney Meeting Report: Reappraisal of microvascular inflammation and the role of biopsy-based transcript diagnostics.
The Banff 2022 Kidney Meeting Report reappraised microvascular inflammation and biopsy-based transcript diagnostics, introducing two new phenotypes, 'probable antibody-mediated rejection' and 'microvascular inflammation, DSA-negative and C4d-negative,' to capture cases that fall outside existing AMR thresholds.
Background
The XVIth Banff Meeting was held in Banff, Alberta, Canada from September 19 to 23, 2022, marking the 30th anniversary of the first Banff Classification. Premeeting discussions considered the past, present, and future of the classification, with a central focus on how microvascular inflammation and molecular diagnostics should be incorporated into the diagnosis of antibody-mediated rejection (AMR).
Key recommendations
Through a postmeeting survey, consensus was reached on delineating two phenotypes: 'probable AMR,' representing donor-specific antibody (DSA)-positive cases with some histologic features of AMR but below current diagnostic thresholds; and 'microvascular inflammation, DSA-negative and C4d-negative,' a phenotype of unclear cause requiring further study. Biopsy-based transcript diagnostics were considered promising and retained as an integral part of the classification, limited to the diagnosis of AMR.
Clinical implications
These refinements expand the classification to capture more biopsies and enable further study of lesions whose clinical significance is not yet defined. Further work is needed to agree on the exact molecular classifiers, thresholds, and clinical context of use before transcript-based diagnostics can be routinely integrated into transplant care.
Category
Transplant
Source
Am J Transplant
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