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Too Many Banff Rejection Subcategories?

12273.1 - Too Many Banff Rejection Subcategories? Using Activity and Chronicity Indices to Simplify the System

Presenter: Lynn Cornell, Mark Haas, Maarten Naesens, Surya V Seshan, , ,
Authors: Lynn Cornell, Mark Haas, Maarten Naesens, Surya V Seshan, Candice Roufosse, Brian Nankivell

Participants


Candice Roufosse, United Kingdom
Moderator
Bio

Brian Nankivell, Australia
Moderator
Bio

Lynn Cornell, United States
Speaker
Bio

Mark Haas, United States
Speaker
Bio

Maarten Naesens, Belgium
Speaker
Bio

Surya Seshan, USA
Speaker
Bio

Overview

The Banff Activity and Chronicity Indices Working Group seeks a wider consensus from the International Transplant community in the development and incorporation of these indices in assessment of kidney transplant rejection, using the existing standardized and validated Banff lesion scores for the individual pathologic findings, for potential clinical utility and rationale for supplementing the pathology reporting of transplant kidney biopsies.

Learning Objectives

  • To review the current Banff kidney transplant rejection classification and its complex subcategories (active, chronic-active, chronic), from the clinical and the pathological perspective.
  • To justify the development of activity and chronicity indices based on Banff lesion scores, to simplify the evaluation of rejection activity and chronicity while adding precision.
  • To further discuss whether this could stratify patients for prognostic and therapeutic decisions, eventually replacing the subcategories of active, chronic-active and chronic forms of T-cell mediated and antibody mediated rejection.
  • Initiate active discussion and encourage input from the audience regarding the potential of activity and chronicity indices to predict prognosis, response to therapy and allograft outcome.

Supporting Material

  1. Naesens M, Cornell LD, Seshan SV, Haas M.
    Towards activity and chronicity indices for the staging of kidney transplant rejection: a viewpoint by the Banff Working Group.
    Transplantation, 2025 Jan 28. doi: 10.1097/TP.0000000000005336. Epub ahead of print. PMID: 39883028
  2. Haas M, Mirocha J, Huang E, et al.
    A Banff-based histologic chronicity index is associated with graft loss in patients with a kidney transplant and antibody-mediated rejection.
    Kidney Int. 2023;103(1): 187-195.
  3. Vaulet T, Divard G, Thaunat O, et al.
    Data-driven Derivation and Validation of Novel Phenotypes for Acute Kidney Transplant Rejection using Semi-supervised Clustering.
    J Am Soc Nephrol. 2021.
  4. Vaulet T, Divard G, Thaunat O, et al.
    Data-Driven Chronic Allograft Phenotypes: A Novel and Validated Complement for Histologic Assessment of Kidney Transplant Biopsies.
    J Am Soc Nephrol. 2022;33(11): 2026-2039.
  5. Naesens M, Haas M. et al.
    Towards activity and chronicity indices for the evaluation of kidney transplant rejection: a viewpoint by the Banff Working Group.
    Transplantation 2025 (in press)

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