Kidney nontumor
Renal allograft
Banff classification of rejection

Topic Completed: 1 December 2012

Minor changes: 21 June 2020

Copyright: 2003-2020,, Inc.

PubMed Search: Banff classification of rejection [title] "loattrfree full text"[sb]

Nikhil Sangle, M.D.
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Cite this page: Sangle N. Banff classification of rejection. website. Accessed July 7th, 2020.
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:
    Missing Image

    Intimal arteritis (v2)

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    Tubulitis (t3)

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    Extensive tubular
    atrophy and
    interstitial fibrosis
    (IFTA Grade III)

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