The Banff Classification of Allograft Pathology is an international consensus classification for the reporting of biopsies from solid organ transplants. Since its initial conception in for renal transplants, it has undergone review every 2 years, with attendant updated publications. From small beginnings in , the Banff working classification of renal allograft pathology has grown to be a major force for setting standards in renal transplant. Abstract. Background. The Banff classification for assessment of renal allograft biopsies was introduced as a standardized international classification of rena.


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Grade III acute rejection: CAN was thought to include at least four entities at that period of time viz. The features suggestive of chronic rejection were: Glomerular basement membrane duplication and mesangial cell proliferation, and b vasculopathy: Fibrous intimal thickening often with fragmentation of banff classification elastic lamina.

banff classification

Banff Classification - Wikipedia

Chronic changes in the interstitium banff classificationtubules ctvessels cvand glomerulus cg were likewise graded into 0, 1, 2, and 3. The severity of interstitial fibrosis and tubular atrophy, banff classification also chronic transplant glomerulopathy and vasculopathy were used to grade CAN into mild, moderate, and severe.

Two other classification systems which developed around this time deserve mention.

Chronic allograft damage index Chronic allograft damage index CADI score was first developed in Diffuse or focal inflammation, interstitial fibrosis, increase in mesangial matrix, glomeruloscerosis, intimal proliferation of vessels and tubular atrophy. Cooperative clinical trials in transplantation system Inpathologists in centers participating in the cooperative clinical trials in transplantation CCTT sponsored by the National Institutes of Health developed a scoring system based on Banff for the diagnosis of acute rejection.

This banff classification named as the CCTT system,[ 8 ] which was more simple and objective. It recognized the banff classification of vasculitis per sec, as it has implications for response to therapy and graft survival.

Pathology Outlines - Banff classification of rejection

Type II rejection was defined by arterial or arteriolar endothelialitis and type III by fibrinoid necrosis or transmural inflammation. These criteria were subsequently incorporated in the Banff '97 schema.

Currently, the CCTT system is no longer used independently. Banff '97 Banff '97 constitutes a landmark document in the field of banff classification transplant pathology. To banff classification the accuracy and quality of the observations on which the banff classification was performed and to audit possible errors, the original biopsy reports, which did not use the Banff criteria, were reviewed at this stage.


Reports which appeared to be at variance with the Banff score were then re-evaluated by WDB and banff classification made where they seemed appropriate. Of the 46, 37 were given scores of increased severity, four were decreased and five were placed in the widespread necrosis category, a non-BANFF group.

The most frequent category revisions were normal revised to borderline banff classification cases and borderline revised to AR I 12 casesdue to identification of grades of tubulitis not recognized at initial examination.

Banff Classification

It should be emphasized that although clinical data would have influenced the categorization of the banff classification biopsy reports, changes made to banff classification Banff categories were dependent only on morphological features. The definition of rejection or otherwise in this biopsy study is based on histology alone.

When patients had more than one satisfactory biopsy taken banff classification days 2 and 35 after transplantation, the banff classification showing the most severe changes according to the Banff criteria was selected as predictive for that patient.

The number of actual courses of methyl prednisolone given for treatment of rejection was retrieved from a computer database, which has been used to prospectively record the number of treatments of methyl prednisolone given to each patient following transplantation among other data.

The long-term outcome for the groups showing each Banff grade was banff classification in terms of actual 3-month, 1-year, 3-year and 5-year graft survival. Results Three hundred and eighty-three consecutive patients underwent renal transplantation at the Oxford Transplant Centre between May and December The percentage of patients allocated banff classification each Banff category is shown graphically in Figure 1.

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The two variants of cellular tubulo-interstitial rejection were less common: Vascular rejection was even less common: Four of these cases were subsequently proven to have been due to renal vein thrombosis of the graft.

Chart showing the percentage of study patients allocated to each Banff category taking the worst biopsy for each patient. View large Download slide Chart showing the percentage banff classification study patients allocated to each Banff category taking the worst biopsy for banff classification patient.

The outcome in terms of graft survival for patients with biopsies in each Banff category is shown graphically in Figure 2.

  • A Reference Guide to the Banff Classification of Renal Allograft Pathology.
  • A 2018 Reference Guide to the Banff Classification of Renal Allograft Pathology.
  • Introduction