Banff 97 diagnostic categories for renal allograft biopsies Banff’05 update

2007年4月17日

1.Normal

2. Antibody-mediated rejection Due to documented anti-donor antibody (‘suspicious for’ if antibody not demonstrated); (may coincide with categories 3-6)

Acute antibody-mediated rejectionType (grade) I. ATN-like – C4d+, minimal inflammation

II. Capillary-margination and/or thromboses, C4d+

III. Arterial -v3, C4d+

Chronic active antibody-mediated rejection Glomerular double contours and/or peritubular capillary basement membrane multilayering and/or interstitial fibrosis/tubular atrophy and/or fibrous intimal thickening in arteries, C4d+

3. Borderline changes: ‘suspicious’ for acute T-cell-mediated rejection This category is used when no intimal arteritis is present, but there are foci of tubulitis (t1, t2 or t3 with i0 or i1) although the i2 t2 threshold for rejection diagnosis is not met (may coincide with categories2, 5 and 6)

4. T-cell-mediated rejection1 (may coincide with categories 2, 5 and 6)

Acute T-cell-mediated rejectionType (grade) IA. Cases with significant interstitial infiltration (>25% of parenchyma affected, i2 or i3) and foci of moderate tubulitis (t2)

IB. Cases with significant interstitial infiltration (>25% of parenchyma affected, i2 or i3) and foci of severe tubulitis (t3)

IIA. Cases with mild to moderate intimal arteritis (v1 )

IIB. Cases with severe intimal arteritis comprising >25% of the luminal area (v2)

III. Cases with ‘transmural’ arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation (v3)

Chronic active T-cell-mediated rejection

‘Chronic allograft arteriopathy’ (arterial intimal fibrosis with mononuclear cell infiltration in fibrosis, formation of neo-intima)

5. Interstitial fibrosis and tubular atrophy, no evidence of any specific etiology

Grade I. Mild interstitial fibrosis and tubular atrophy (<25% of cortical area) II. Moderate interstitial fibrosis and tubular atrophy (26-50% of cortical area)

III. Severe interstitial fibrosis and tubular atrophy/loss (>50% of cortical area)

(may include non-specific vascular and glomerular sclerosis, but severity graded by tubulointerstitial features)

6. Other: Changes not considered to be due to rejection-acute and/or chronic; may coincide with ategories 2-5

The proposal of quantitative criteria for peritubular capillary margination of inflammatory cells (‘ptc’) score Use asterisk (*) to indicate only mononuclear cells and absence of neutrophils. きちんと輪切りになり、かつ最も高度なptcで評価を行う。
ptc0	no significant cortical peritubular inflammatory changes
ptc1	cortical peritubular capillary with 3-4 luminal inflammatory cells
ptc2	cortical peritubular capillary with 5-10 luminal inflammatory cells
ptc3	cortical peritubular capillary with >10 luminal inflammatory cells

Solez K, Colvin RB, Racusen LC, Sis B, Halloran PF, Birk PE, Campbell PM, Cascalho M, Collins AB, Demetris AJ, Drachenberg CB, Gibson IW, Grimm PC, Haas M, Lerut E, Liapis H, Mannon RB, Marcus PB, Mengel M, Mihatsch MJ, Nankivell BJ, Nickeleit V, Papadimitriou JC, Platt JL, Randhawa P, Roberts I, Salinas-Madriga L, Salomon DR, Seron D, Sheaff M, Weening JJ. Abstract Banff ’05 Meeting Report: differential diagnosis of chronic allograft injury and elimination of chronic allograft nephropathy (‘CAN’).　Am J Transplant. 2007 Mar;7(3):518-26.

執筆日：2007/04/17

執筆者：神戸大学病院病理部病理診断科　伊藤　智雄

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