SELECTED HIGHLIGHTS OF THE BANFF CONFERENCE ON ALLOGRAFT PATHOLOGY, AUGUST 2013, COMANDATUBA, BAHIA, BRAZIL
The Banff series of conferences on allograft pathology have been taking place every 2 years since 1991. These meetings are directed by Dr. Kim Solez, Professor of Pathology at University of Alberta at Edmonton, and Dr Lorraine Racusen, Professor of Pathology at Johns Hopkins Medical Institutions, Baltimore, Maryland. Selected highlights of the 2013 meeting are summarized below.
Borderline changes for acute rejection
It was decided that the category referred to as “Borderline changes suspicious for acute rejection” be retained for the time being, although its use should be minimized, and diagnostic criteria further refined. While it has been claimed that some ‘borderline’ biopsies can be re-classified as T-cell mediated rejection using molecular methods, the reverse is also true in that some cases of overt histologic rejection are missed by DNA microarray technology.
Renal allograft isolated vasculitis
Renal allograft biopsies with intimal arteritis and no significant associated interstitial inflammation (so called isolated vasculitis) were shown to respond to anti-rejection treatment. Death-censored graft survival is comparable to conventional Banff grade II rejection. Although, a significant proportion of these biopsies are associated with donor-specific antibodies, and the artery intima is infiltrated by T-cells, DNA microarray analysis does not show molecular signals associated with either T-cell proportion are or antibody mediated rejection. This discrepancy reflects a limitation of microarray technology in that it is not well suited to capture the effect of rare events in biopsy material.
Note: Summary 2 of the Banff conference will post tomorrow.
Post written by Parmjeet Randhawa, MD, from the University of Pittsburgh Medical Center, AJKD Associate Editor