Specimen Adequacy andLesion Scoring (Banff '93-95)
Kidney Transplantation

Specimen Adequacy and Lesion Scoring (Banff '93-95)

Specimen Adequacy (a necessary prerequisite for numeric coding)
Unsatisfactory No glomeruli or arteries
Marginal 1-6 glomeruli with artery
Adequate 7 or more glomeruli with artery
Minimum Sampling
7 slides 3 H&E, 3 PAS and 1 trichrome

Quantitative Criteria for Tubulitis ("t") Score (assumes minimum sampling)
t0 No mononuclear cells in tubules
t1 Foci with 1 to 4 cells/tubular cross section or 10 tubular cells
t2 Foci with 5 to 10 cells/tubular cross section
t3 Foci with >10 cells/tubular cross section, or the presence of at least two areas of tubular basement membrane destruction accompanied by i2/i3 inflammation and t2 tubulitis elsewhere in the biopsy.

Quantitative Criteria for Mononuclear Cell Interstitial Inflammation ("i")
i0 No or trivial interstitial inflammation
i1 Up to 25% of parenchyma inflamed cells
i2 26 to 50% of parenchyma inflamed
i3 >50% of parenchyma inflamed

Quantitative Criteria for the Early Type of Allograft Glomerulitis ("g")
g0 No glomerulitis
g1 Glomerulitis in a minority of glomeruli
g2 Segmental or global glomerulitis in about 25 to 75% of glomeruli
g3 Glomerulitis (mostly global) in all or almost all glomeruli

Quantitative Criteria for Arteriolar Hyaline Thickening ("ah")
ah0 No PAS-positive hyaline thickening
ah1 Mild-to-moderate PAS-positive hyaline thickening in at least one arteriole
ah2 Moderate-to-severe PAS-positive hyaline thickening in more than one arteriole
ah3 Severe PAS-positive hyaline thickening in many arterioles

Quantitative Criteria for Intimal Arteritis ("v")
v0 No arteritis
v1 Mild-to-moderate intimal arteritis in at least one arterial cross section
v2 Moderate-to-severe intimal arteritis in more than one arterial cross section
v3 Severe intimal arteritis in many arterial cross sections and/or "transmural" arteritis, fibrinoid change and medial smooth muscle necrosis, often with patchy infarction and interstitial hemorrhage

Quantitative Criteria for Allograft Glomerulopathy ("cg")
cg0 No glomerulopathy
cg1 Mesangial matrix expansion and BM thickening, ± double contours, in capillary loops affecting up to 25% of nonsclerotic glomeruli
cg2 Increasd severity of changes described above affecting 26 to 50% of nonsclerotic glomeruli
cg3 Severe changes of classic transplant glomerulopathy affecting more than 50% of nonsclerotic glomeruli and with double contours in many capillary loops

Quantitative Criteria for Interstitial Fibrosis ("ci")
ci0 Interstitial fibrosis tissue in up to 5% of cortical area
ci1 Mild Interstitial fibrosis tissue in 6 to 25% of cortical area
ci2 Moderate interstitial fibrosis of 26 to 50% of cortical area
ci3 Moderate interstitial fibrosis of >50% of cortical area

Quantitative Criteria for Tubular Atrophy ("ct")
ct0 No tubular atrophy
ct1 Tubular atrophy in up to 25% of the area of cortical tubules
ct2 Tubular atrophy involving 26 to 50% of the area of cortical tubules
ct3 Tubular atrophy of >50% of the area of cortical tubules

Quantitative Criteria for Fibrous Intimal Thickening ("cv")
cv0 No chronic vascular changes
cv1 Vascular narrowing of up to 25% lumenal area by fibrointimal thickening of arteries ± breach of internal elastic lamina or presence of foam cells or occasional mononuclear cells
cv2 Increased severity of changes described above with 26 to 50% narrowing of vascular lumenal area
cv3 Severe vascular changes with >50% narrowing of vascular lumenal area

  1. Solez K, et al. International standardization of criteria for the histologic diagnosis of renal allograft rejection: The Banff working classification of kidney transplantation. Kidney Int 1993;44(2):411-22.
  2. Solez K, et al. Report of the third Banff conference on allograft pathology (July 20-24, 1995) on classification and lesion scoring in renal allograft pathology. Trans Proc 1996;28(1):441-4.

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Last Modified: Thu Jun 18 10:14:08 EDT 2009