A 2020 Banff Antibody-mediatedInjury Working Group examination of international practices for diagnosing antibody-mediated rejection in kidney transplantation – a cohort study

Carrie A. Schinstock, Medhat Askar, Serena M. Bagnasco, Ibrahim Batal, Laurine Bow, Klemens Budde, Patricia Campbell, Robert Carroll, Marian C. Clahsen-van Groningen, Matthew Cooper, Lynn D. Cornell, Emanuele Cozzi, Darshana Dadhania, Fritz Diekmann, Dennis A. Hesselink, Annette Jackson, Zeljko Kikic, Fritz Lower, Maarten Naesens, Joris J. RoelofsRuth Sapir-Pichhadze, Edward S. Kraus

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)488-498
Number of pages11
JournalTransplant International
Volume34
Issue number3
DOIs
StatePublished - Mar 2021

Keywords

  • histocompatibility and immunogenetics
  • HLA-antibody post-transplantation
  • kidney clinical
  • pre-sensitisation
  • rejection

ASJC Scopus subject areas

  • Transplantation

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