Kidney nontumor
Diseases of renal allograft
Banff classification of rejection

Author: Nikhil Sangle, M.D. (see Authors page)

Revised: 23 March 2018, last major update December 2012

Copyright: (c) 2003-2018,, Inc.

PubMed Search: Banff classification of rejection

Cite this page: Sangle, N. Banff classification of rejection. website. Accessed March 24th, 2018.
Definition / general
  • Banff classification (Am J Transplant 2008;8:753) of Renal Allograft Pathology updated Banff '97 classification
  • Adequate core biopsy must contain 10 glomeruli and 2 arteries (marginal if 7 - 10 glomeruli and 1 artery; unsatisfactory if < 7 glomeruli or no arteries)
  • Every renal allograft biopsy should be stained for C4d

    1. Normal

    2. Antibody-mediated rejection: C4d deposition, acute antibody-mediated, chronic active antibody-mediated

    3. Borderline changes: “suspicious” for acute T cell mediated rejection

    4. T cell mediated rejection:
    Acute T cell mediated rejection
    Type IA: Cases with significant interstitial infiltration (> 25% of parenchyma affected, i2 or i3) and foci of moderate tubulitis (t2)
    Type IB: Cases with significant interstitial infiltration (> 25% of parenchyma affected, i2 or i3) and foci of severe tubulitis (t3)
    Type IIA: Cases with mild to moderate intimal arteritis (v1)
    Type IIB: Cases with severe intimal arteritis comprising > 25% of luminal area (v2)
    Type III: Cases with “transmural” arteritis or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation (v3)
    Chonic 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 evidency of any specific etiology
    Grade I: Mild interstitial fibrosis and tubular atrophy (< 25% of cortical area)
    Grade II: Moderate interstitial fibrosis and tubular atrophy (26 - 50% of cortical area)
    Grade III: Severe interstitial fibrosis and tubular atrophy/loss (> 50% of cortical area)

    6. Other: Changes not considered to be due to rejection

    Quantitative criteria for mononuclear cell interstitial inflammation:
    ti0: no or trivial interstitial inflammation (< 10% of parenchyma)
    ti1: 10 - 25% of parenchyma inflamed
    ti2: 26 - 50% of parenchyma inflamed
    ti3: > 50% of parenchyma inflamed

  • References: Evolution of Banff schema (Indian J Nephrol 2010;20:2), no change in 2011, next meeting in 2013 (Am J Transplant 2012;12:563)
Microscopic (histologic) images

Images hosted on other servers:
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Borderline rejection

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Intimal arteritis (v2)

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Tubulitis (t3)

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Extensive tubular atrophy and interstitial fibrosis (IFTA Grade III)