Specimen Adequacy and Lesion Scoring (Banff '97)
Kidney Transplantation

Specimen Adequacy and Lesion Scoring (Banff '97)


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Specimen Adequacy (a necessary prerequisite for numeric coding)
Unsatisfactory Less than 7 glomeruli & no arteries
Marginal 7 glomeruli with one artery
Adequate 10 or more glomeruli with at least two arteries
Minimum Sampling
7 slides 3 H&E, 3 PAS or silver stains, and 1 trichrome, section thickness 3-4 microns.

Quantitative Criteria for Tubulitis ("t") Score (assumes minimum sampling)
t0 No mononuclear cells in tubules  WS
t1 Foci with 1 to 4 cells/tubular cross section or 10 tubular cells  WS
t2 Foci with 5 to 10 cells/tubular cross section  WS
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.  WS

Quantitative Criteria for Mononuclear Cell Interstitial Inflammation ("i")
i0 No or trivial interstitial inflammation (<10% of unscarred parenchyma)  WS
i1 10 to 25% of parenchyma inflamed cells  WS
i2 26 to 50% of parenchyma inflamed
i3 >50% of parenchyma inflamed  WS
Indicate presence of remarkable numbers (>10% of total cells) of eosinophils, polys, or plasma cells (specify which) with an asterisk on i

Quantitative Criteria for the Early Type of Allograft Glomerulitis ("g")
g0 No glomerulitis  WS
g1 Glomerulitis in <25% of glomeruli  WS
g2 Segmental or global glomerulitis in about 25 to 75% of glomeruli  WS
g3 Glomerulitis (mostly global) in >75% 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
Indicate arteriolitis (significance unknown) by an asterisk on ah

Quantitative Criteria for Intimal Arteritis ("v")
v0 No arteritis  WS
v1 Mild-to-moderate intimal arteritis in at least one arterial cross section  WS
v2 Severe intimal arteritis with at least 25% luminal area lost in at least one arterial cross section  WS
v3 Arterial fibrinoid change and/or transmural arteritis with medial smooth muscle necrosis with lymphocytic inflammation  WS
Note number of arteries present and number affected. Indicate infarction and/or interstitial hemorrhage by an asterisk (with any level v score)

Quantitative Criteria for Allograft Glomerulopathy ("cg")
cg0 No glomerulopathy, double contours in <10% of peripheral capillary loops in most severely affected glomerulus
cg1 Double contours affecting up to 25% of peripheral capillary loops in the most affected of nonsclerotic glomeruli
cg2 Double contours affecting 26 to 50% of peripheral capillary loops in the most affected of nonsclerotic glomeruli
cg3 Double contours affecting more than 50% of peripheral capillary loops in the most affected of nonsclerotic glomeruli
Note number of glomeruli and percentage sclerotic

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 Severe 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*
* in most severely affected vessel. Note if lesions characteristic of chronic rejection (elastica breaks, inflammatory cells in fibrosis, formation of neointima) are seen

Quantitative Criteria for Mesangial Matrix Increase ("mm")*
mm0 No mesangial matrix increase
mm1 Up to 25% of nonsclerotic glomeruli affected (at least moderate matrix increase)
mm2 26-50% of nonsclerotic glomeruli affected (at least moderate matrix increase)
mm3 >50% of nonsclerotic glomeruli affected (at least moderate matrix increase)
* The threshold criterion for the moderately increased "mm" is the expanded mesangial interspace between adjacent capillaries. If the width of the interspace exceeds two mesangial cells on the average in at least two glomerular lobules the "mm" is moderately increased

References
  1. Solez K, et al. International standardization of criteria for the histologic diagnosis of renal allograft rejection: The Banff working classification of kidney transplant pathology. 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.
  3. Racusen L, et al. The Banff 97 working classification of renal allograft pathology. Kidney Int 1999;55:713-723


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