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Kidney non-tumor

Kidney transplantation

Banff classification of rejection


Reviewers: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 25 December 2012, last major update September 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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Banff '07 classifcation 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)

Micro images
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Histopathologic lesions of acute rejection as defined by Banff 97 classification


Borderline rejection


Intimal arteritis (v2)


Tubulitis (t3)


Extensive tubular atrophy and interstitial fibrosis (IFTA Grade III)

End of Kidney non-tumor > Kidney transplantation > Banff classification of rejection

Ref Updated: 9/4/12


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