The Banff 97 working classification of renal allograft pathology
The Banff 97 working classification of renal allograft pathology
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DOI：
10.1046/j.1523-1755.1999.00299.x
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发表时间：
1999-02-01
影响因子：
19.6
通讯作者：
Yamaguchi, Y
中科院分区：
文献类型：
--
作者：
Racusen, LC;Solez, K;Yamaguchi, Y
背景移植肾活检的标准化解释对于指导治疗和建立临床试验的客观终点是必要的。本文描述了一个分类，班夫97，开发的研究人员使用班夫模式和合作临床试验移植（CCTT）的修改诊断肾移植病理学。班夫97从班夫开始的国际共识讨论中成长起来，并通过互联网继续下去。该模式的发展来自（a）使用Banff分类法的数据分析，（B）CCT修改的出版物和经验，（c）国际会议，和（d）最近关于血管炎对移植结果影响的研究数据。半定量病变评分继续关注小管炎和动脉炎，但包括间质性炎症的最低阈值。Banff 97定义了急性/主动排斥的“类型”。I型为无动脉炎的肾小管间质排斥反应。II型为血管性排斥反应伴内膜动脉炎，III型为严重排斥反应伴透壁动脉改变。只有轻度炎症的活检被分级为“临界/疑似排斥"。慢性/硬化性同种异体移植物变化根据肾小管萎缩和间质纤维化的严重程度进行分级。抗体介导的排斥反应，超急性或加速急性的表现，也被分类，因为是其他重要的同种异体移植物的发现。班夫97工作分类细化了早期的模式，并代表了全球临床排斥试验和临床实践中最广泛使用的两种分类的输入。主要变化包括：血管炎排斥反应与肾小管间质排斥反应分开;严重排斥反应需要动脉的透壁变化;“临界”排斥反应只能在临床背景下解释;抗体介导的排斥反应得到进一步定义，病变评分侧重于最严重的受累结构。样本充足性标准也已修改。Banff 97代表了通过国际共识讨论制定的同种异体移植评估的重要改进。
Background. Standardization of renal allograft biopsy interpretation is necessary to guide therapy and to establish an objective end point for clinical trials. This manuscript describes a classification, Banff 97, developed by investigators using the Banff Schema and the Collaborative Clinical Trials in Transplantation (CCTT) modification for diagnosis of renal allograft pathology.Methods. Banff 97 grew from an international consensus discussion begun at Banff and continued via the Internet. This schema developed from (a) analysis of data using the Banff classification, (b) publication of and experience with the CCTT modification, (c) international conferences, and (d) data from recent studies on impact of vasculitis on transplant outcome.Results. Semiquantitative lesion scoring continues to focus on tubulitis and arteritis but includes a minimum threshold for interstitial inflammation. Banff 97 defines "types" of acute/active rejection. Type I is tubulointerstitial rejection without arteritis. Type II is vascular rejection with intimal arteritis, and type III is severe rejection with transmural arterial changes. Biopsies with only mild inflammation are graded as "borderline/suspicious for rejection." Chronic/sclerosing allograft changes are graded based on severity of tubular atrophy and interstitial fibrosis. Antibody-mediated rejection, hyperacute or accelerated acute in presentation, is also categorized, as are other significant allograft findings.Conclusions. The Banff 97 working classification refines earlier schemas and represents input from two classifications most widely used in clinical rejection trials and in clinical practice worldwide. Major changes include the following: rejection with vasculitis is separated from tubulointerstitial rejection; severe rejection requires transmural changes in arteries; "borderline" rejection can only be interpreted in a clinical context; antibody-mediated rejection is further defined, and lesion scoring focuses on most severely involved structures. Criteria for specimen adequacy have also been modified. Banff 97 represents a significant refinement of allograft assessment, developed via international consensus discussions.