TY - JOUR
T1 - A 2020 Banff Antibody-mediatedInjury Working Group examination of international practices for diagnosing antibody-mediated rejection in kidney transplantation – a cohort study
AU - Schinstock, Carrie A.
AU - Askar, Medhat
AU - Bagnasco, Serena M.
AU - Batal, Ibrahim
AU - Bow, Laurine
AU - Budde, Klemens
AU - Campbell, Patricia
AU - Carroll, Robert
AU - Clahsen-van Groningen, Marian C.
AU - Cooper, Matthew
AU - Cornell, Lynn D.
AU - Cozzi, Emanuele
AU - Dadhania, Darshana
AU - Diekmann, Fritz
AU - Hesselink, Dennis A.
AU - Jackson, Annette M.
AU - Kikic, Zeljko
AU - Lower, Fritz
AU - Naesens, Maarten
AU - Roelofs, Joris J.
AU - Sapir-Pichhadze, Ruth
AU - Kraus, Edward S.
N1 - Funding Information: The authors have declared no funding. We thank the Banff Foundation for Allograft Pathology for supporting our work. Publisher Copyright: © 2021 Steunstichting ESOT. Published by John Wiley & Sons Ltd
PY - 2021/3/1
Y1 - 2021/3/1
N2 - The Banff antibody-mediated rejection (ABMR) classification is vulnerable to misinterpretation, but the reasons are unclear. To better understand this vulnerability, we evaluated how ABMR is diagnosed in practice. To do this, the Banff Antibody-Mediated Injury Workgroup electronically surveyed an international cohort of nephrologists/surgeons (n = 133) and renal pathologists (n = 99). Most providers (97%) responded that they use the Banff ABMR classification at least sometimes, but DSA information is often not readily available. Only 41.1% (55/133) of nephrologists/surgeons and 19.2% (19/99) of pathologists reported that they always have DSA results when the biopsy is available. Additionally, only 19.6% (26/133) of nephrologists/surgeons responded that non-HLA antibody or molecular transcripts are obtained when ABMR histologic features are present but DSA is undetected. Several respondents agreed that histologic features concerning for ABMR in the absence of DSA and/or C4d are not well accounted for in the current classification [31.3% (31/99) pathologists and 37.6% (50/133) nephrologist/surgeons]. The Banff ABMR classification appears widely accepted, but efforts to improve the accessibility of DSA information for the multidisciplinary care team are needed. Further clarity is also needed in Banff ABMR nomenclature to account for the spectrum of ABMR and for histologic features suspicious for ABMR when DSA is absent.
AB - The Banff antibody-mediated rejection (ABMR) classification is vulnerable to misinterpretation, but the reasons are unclear. To better understand this vulnerability, we evaluated how ABMR is diagnosed in practice. To do this, the Banff Antibody-Mediated Injury Workgroup electronically surveyed an international cohort of nephrologists/surgeons (n = 133) and renal pathologists (n = 99). Most providers (97%) responded that they use the Banff ABMR classification at least sometimes, but DSA information is often not readily available. Only 41.1% (55/133) of nephrologists/surgeons and 19.2% (19/99) of pathologists reported that they always have DSA results when the biopsy is available. Additionally, only 19.6% (26/133) of nephrologists/surgeons responded that non-HLA antibody or molecular transcripts are obtained when ABMR histologic features are present but DSA is undetected. Several respondents agreed that histologic features concerning for ABMR in the absence of DSA and/or C4d are not well accounted for in the current classification [31.3% (31/99) pathologists and 37.6% (50/133) nephrologist/surgeons]. The Banff ABMR classification appears widely accepted, but efforts to improve the accessibility of DSA information for the multidisciplinary care team are needed. Further clarity is also needed in Banff ABMR nomenclature to account for the spectrum of ABMR and for histologic features suspicious for ABMR when DSA is absent.
KW - HLA-antibody post-transplantation
KW - histocompatibility and immunogenetics
KW - kidney clinical
KW - pre-sensitisation
KW - rejection
UR - http://www.scopus.com/inward/record.url?scp=85102145693&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/tri.13813
DO - https://doi.org/10.1111/tri.13813
M3 - Article
C2 - 33423340
SN - 0934-0874
VL - 34
SP - 488
EP - 498
JO - Transplant international
JF - Transplant international
IS - 3
ER -