Diagnostic Categories for Renal Allograft Biopsies ('95)*
|
1. Normal, see Definitions |
2. Hyperacute Rejection |
Rejection presumed to be due to preformed antibody, usually characterized
by polymorph accumulation in glomerular and peritubular capillaries at one
hour post-transplant with subsequent endothelial damage and capillary
thrombosis
|
3. Borderline Changes |
Grade |
Histopathological Findings |
"very mild acute rejection"
|
This category is used when no
intimal arteritis
is present, but there is a mild or moderate focal mononuclear cell infiltration
with foci of mild tubulitis (1 to 4 mononuclear cells/tubular cross
section) |
4. Acute Rejection |
Grade |
Histopathological Findings |
Grade I (mild) |
Cases with significant interstitial infiltration
(> 25% of parenchyma affected) and foci of moderate tubulitis (>
4 mononuclear cells/tubular cross section or group of 10 tubular cells)
|
Grade II (moderate) |
Cases with (A) significant interstitial infiltration
and foci of severe tubulitis (> 10 mononuclear cells/tubular cross
section) and/or (B) mild or moderate intimal arteritis and/or (C)
two foci of tubular basement membrane destruction with infiltrates
of i2/i3 intensity
|
Grade III (severe) |
Cases with severe intimal arteritis and/or
"transmural" arteritis with fibrinoid change and necrosis of medial
smooth muscle cells. Recent focal infarction and interstitial hemorrhage
without other obvious cause are also regarded as evidence for Grade III
rejection |
5. Chronic Allograft Nephropathy§ |
Grade |
Histopathological Findings |
Grade I (mild) |
Mild chronic ischaemic or transplant
glomerulopathy
|
Mild interstitial fibrosis and tubular
atrophy |
Grade II (moderate) |
Moderate chronic ischaemic or transplant
glomerulopathy
|
Moderate interstitial fibrosis and tubular atrophy
|
Grade III (severe) |
Severe chronic ischaemic or transplant
glomerulopathy
|
Severe interstitial fibrosis and tubular atrophy
and tubular loss |
6. Other |
Changes not considered to be due to rejection,
see Differential Diagnosis |
§ Glomerular and vascular lesions help define type of chronic
nephropathy; new-onset arterial fibrous intimal thickening suggests the
presence of chronic rejection
|
*
The recommended format of report is a descriptive narrative
signout followed by numerical codes (Banff
'93-95, Banff '97) in
parentheses. Categorization should in the first instance be based solely
on pathologic changes, then integrated with clinical data as a second step.
More than one diagnostic category may be used if appropriate
|
References
- 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.
- 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.
|