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The kidneys
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Renal transplantation is the optimum renal replacement therapy for most patients with ESRD. Transplants may come from cadaveric, living related, or living unrelated donors. Effort is made to match the donor and recipient's major histocompatibility complex (MHC) antigens as closely as possible, because transplant survival is enhanced by good matching, particularly at MHC class II antigens. Advances in immunosuppressive drugs and immunosuppression protocols have reduced the incidence of transplant rejection but pathological assessment of transplant dysfunction is an important part of clinical care. The four main types of rejection and the features found in renal transplant biopsies are summarized in Table 14.4. Clinical treatment decisions are based on the severity of the changes seen in renal transplant biopsy, which are categorized using the Banff classification.
Transplantation
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Allograft rejection manifests itself as functional failure of the transplant and is confirmed by histological examination. Biopsy material is obtained from renal and pancreas grafts by needle biopsy, and from hepatic grafts by percutaneous or transjugular liver biopsy. Cardiac grafts are biopsied by transjugular endomyocardial biopsy and lung grafts by transbronchial biopsy. After small intestinal transplantation, mucosal biopsies are obtained from the graft stoma or more proximally by endoscopy. A standardised histological grading system, termed the Banff classification (named after the Canadian town where the initial scientific workshop was held), defines the presence and severity of allograft rejection after organ transplantation.
Face transplantation
Published in John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan, Operative Oral and Maxillofacial Surgery, 2017
Ahmed M Hashem, Bahar Bassiri Gharb, Risal Djohan
Rejection screening is accomplished according to a predefined protocol and includes punch biopsies from the skin and mucous membrane every 72 hours for the first 2 weeks, then every week for the first 3 months and then once a month for the first year. An experienced pathologist evaluates the specimens by using a consistent rejection scale as the Banff classification.
Applications of Transcriptomics in the Research of Antibody-Mediated Rejection in Kidney Transplantation: Progress and Perspectives
Published in Organogenesis, 2022
The diagnosis of ABMR in the current clinical practice primarily depends on the Banff classification. The Banff Classification of Kidney Allograft Pathology was initially established in August 1991 by a group of pathologists and clinicians in Banff, Alberta, Canada. Diagnostic criteria for acute/active ABMR were first added to the Banff classification after the 2001 conference.19 Since then, Banff conferences have been held every 2 years worldwide, and several major revisions and modifications have been made to improve the diagnostic and prognostic values. According to the most recent Banff 2019 Kidney Meeting Report,20 all three of the criteria listed below must be met for diagnosis: (1) histological evidence of allograft injury via microvascular inflammation (MVI), intimal or transmural arteritis, acute thrombotic microangiopathy, or acute tubular injury in the absence of any other apparent cause; (2) histological evidence of antibody-endothelial interactions either by C4d deposition, at least moderate MVI, or increased expression of gene transcripts/classifiers in the biopsy tissue that have been validated to be strongly associated with ABMR; and (3) the presence of circulating DSA, predominantly HLA antibody. C4d staining or expression of validated transcripts/classifiers as noted in criterion (2) may substitute for DSA, and biopsies meeting criterion 1 but not criterion 2 with current or prior evidence, but not remote DSA, may be stated as showing chronic ABMR.
US payer budget impact of a microarray assay with machine learning to evaluate kidney transplant rejection in for-cause biopsies
Published in Journal of Medical Economics, 2022
Lauren Fusfeld, Sreeranjani Menon, Gaurav Gupta, Christopher Lawrence, Salwa F. Masud, Thomas F. Goss
Grades of rejection are defined by the Banff Classification of Allograft Pathology – established in 1991 and updated regularly as additional research informs consensus, with the most recent criteria set at the 2019 meeting6. Guided by a histology assessment based on the Banff criteria, pathologists exhibit a 30% error rate when evaluating kidney allograft dysfunction7. In addition to inadequate detection of rejection type, clinical interpretation of histology is subjective and, thus, remains prone to inter- and intra-observer variability8–15. Further, as the tissue becomes more abnormal, the likelihood that the pathologist’s assessment departs from Banff criteria increases16. The Banff guidelines themselves can be a limitation, too, as classifications in the guidelines are often ambiguous6,17,18. Lastly, the sample type required by histology may also be a limitation. For example, histology requires 10 glomeruli and two arteries, but the medulla contains none of the required glomeruli; thus, histology alone cannot assess rejection in the medulla of biopsies19.
Eponychial lesions following bilateral upper extremity vascular composite allotransplantation: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2018
Fedra Fallahian, David Molway, Saagar Jadeja, Rachael Clark, Francisco M. Marty, Leonardo V. Riella, Anil Chandraker, Simon G. Talbot
Skin biopsies with histologic examination are a routine method for assessment of VCA rejection. The most common findings seen on pathology in acute rejection are a superficial dermal perivascular infiltrate composed mostly of lymphocytes and epidermal changes consisting of keratinocyte necrosis, basal cell vacuolization, spongiosis, and acanthosis [6]. The Banff working classification for evaluation of VCA rejection was developed in 2007 and is the current standard for diagnosing acute rejection in VCA recipients. It classifies rejection into five grades (0–IV) of increasing severity [7]. As the number of VCAs increases, there are more pathological changes observed that have not been accounted for by the Banff classification. These include graft vasculopathy, dermal sclerosis, epidermal and adnexal atrophy, and capillary thromboses in the skin [6]. The Banff classification is undergoing refinement to include new findings.