Banff Specimen Adequacy and Lesion Scoring
Kidney Transplantation

Specimen Adequacy and Lesion Scoring (Banff components as of 2018)

Specimen Adequacy (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.

ti Score: Total cortical interstitial inflammation
ti0 <10% of total cortical parenchyma with inflammation (No or trivial interstitial inflammation)
ti1 10-25% of total cortical parenchyma with inflammation
ti2 26-50% of total cortical parenchyma with inflammation
ti3 >50% of total cortical parenchyma with inflammation
 

i Score (i-Banff,Interstitial inflammation in unscarred cortical parenchyma)
i0 <10% of unscarred cortical parenchyma with inflammation (No or trivial interstitial inflammation)
i1 10-25% of unscarred cortical parenchyma with inflammation
i2 26-50% of unscarred cortical parenchyma with inflammation
i3 >50% of unscarred cortical parenchyma with inflammation

i-IFTA Score (Interstitial inflammation in scarred cortical parenchyma)
i-IFTA0 <10% of scarred cortical parenchyma with inflammation (No or trivial interstitial inflammation)
i-IFTA1 10-25% of scarred cortical parenchyma with inflammation
i-IFTA2 26-50% of scarred cortical parenchyma with inflammation
i-IFTA3 >50% of scarred cortical parenchyma with inflammation

t Score (t-Banff, tubulitis in unscarred cortical parenchyma)
t0 No mononuclear cells within tubules in unscarred cortical parenchyma
t1 Foci with 1 to 4 cells/tubular cross section or 10 tubular cells in longitudinal section in unscarred cortical parenchyma
t2 Foci with 5 to 10 cells/tubular cross section in unscarred cortical parenchyma
t3 Foci with >10 cells/tubular cross section in unscarred parenchyma, or the presence in unscarred parenchyma of at least two areas of tubular basement membrane destruction accompanied by i2/i3 inflammation and t2 tubulitis elsewhere in the biopsy.

t-IFTA Score (Tubulitis in scarred cortical parenchyma)
t-IFTA0 No mononuclear cells within tubules in scarred cortical parenchyma *(ignoring severely atrophic tubules)
t-IFTA1 Foci with 1 to 4 cells/tubular cross section or 10 tubular cells in longitudinal section in scarred cortical parenchyma *(ignoring severely atrophic tubules)
t-IFTA2 Foci with 5 to 10 cells/tubular cross section in scarred cortical parenchyma *(ignoring severely atrophic tubules)
t-IFTA3 Foci with >10 cells/tubular cross section in scarred parenchyma, or the presence in scarred parenchyma of at least two areas of tubular basement membrane destruction accompanied by i2/i3 inflammation and t2 tubulitis elsewhere in the biopsy *(ignoring severely atrophic tubules).
*Note: A severely atrophic tubule has each of the following 3 features: a) diameter <25% of that of unaffected or minimally affected tubules; b) undifferentiated-appearing cuboidal or flattened epithelium; c) pronounced wrinkling and/or thickening of the tubular basement membrane

g Score (Glomerulitis)
g0 No glomerulitis
g1 Segmental or global glomerulitis in <25% of glomeruli
g2 Segmental or global glomerulitis in 25 to 75% of glomeruli
g3 Segmental or global glomerulitis in >75% glomeruli

ah Score (Arteriolar hyalinosis)
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
1. Indicate arteriolitis (significance unknown) if present by an asterisk on the ah score
2. An alternative scoring approach that focuses on partial or circumferential hyalinosis is designated aah, but is not presently employed diagnostically

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

cg Score (Chronic glomerulopathy)
cg0 No evidence of glomerular basement membrane (GBM) double contours by light or electron microscopy
cg1a Electron microscopic evidence of partial or circumferential GBM double contours in 3 or more glomerular capillaries (with subendothelial electron lucency and/or endothelial swelling)
cg1b Light microscopic evidence of 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
 

ci Score (Interstitial fibrosis)
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

ct Score (Tubular atrophy)
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

cv Score (Fibrous intimal thickening)
cv0 No chronic vascular changes
cv1 Vascular narrowing of up to 25% luminal area by fibrointimal thickening in most severely affected artery
cv2 Vascular narrowing of 26-50% luminal area by fibrointimal thickening in most severely affected artery
cv3 Vascular narrowing o f>50% luminal area by fibrointimal thickening in most severely affected artery
 

mm Score (Mesangial matrix increase)
mm0 No or mild 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

ptc Score (Peritubular capillaritis)
ptc0 At least 1 leukocyte in <10% of cortical peritubular capillaries and/or maximum number of luekocytes in ptc <3
ptc1 At least 1 leukocyte in 10% or more or cortical peritubular capillaries with 3-4 leukocytes in maximally involved ptc
ptc2 At least 1 leukocyte in 10% or more or cortical peritubular capillaries with 5-10 leukocytes in maximally involved ptc
ptc3 At least 1 leukocyte in 10% or more or cortical peritubular capillaries with>10 leukocytes in maximally involved ptc
 

C4d Score (C4d immunostaining of cortical peritubular capillaries and/or medullary vasa recta)
C4d0 No evidence of C4d staining in peritubular capillaries and/or vasa recta
C4d1 Minimal- C4d staining in <10% of peritubular capillaries and/or vasa recta
C4d2 Focal- C4d staining in 10-50% of peritubular capillaries and/or vasa recta
C4d3 Diffuse- C4d staining in >50% of peritubular capillaries and/or vasa recta
 

References
  1. Roufosse C, Simmonds N, Clahsen-van Groningen M, Haas M, Henriksen KJ, Horsfield C, Loupy A, Mengel M, Perkowska-Ptasinska A, Rabant M, Racusen LC, Solez K, Becker JU. A 2018 reference guide to the Banff Classification of renal allograft pathology. Transplantation 2018 102(11):1795-1814.
  2. Haas M, Loupy A, Lefaucheur C, Roufosse C, Glotz D, Seron D, Nankivell BJ, Halloran PF, Colvin RB, Akalin E, Alachkar N, Bagnasco S, Bouatou Y, Becker JU, Cornell LD, Duong va Huenn JP, Gibson IW, Kraus ES, Mannon RB, Naesens M, Nickeleit V, Nickerson P, Segev DL, Singh HK, Stegall M, Randhawa P, Racusen L, Solez K, Mengel M. The Banff 2017 kidney meeting report: Revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials. Am J Transplant 2018;18:293-307.
  3. Loupy A, Haas M, Solez K, Racusen L, Glotz D, Seron D, Nankivell BJ, Colvin RB, Afrouzian M, Akalin E, Alachkar N, Bagnasco S, Becker JU, Cornell L, Drachenberg C, Dragun D, de Kort H, Gibson IW, Kraus ES, Lefaucheur C, Legendre C, Liapis H, Muthukumar T, Nickeleit V, Orandi B, Park W, Rabant M, Randhawa P, Reed EF, Roufosse C, Seshan SV, Sis B, Singh HK, Schinstock C, Tambur A, Zeevi Z, Mengel M. The Banff 2015 kidney meeting report: Current challenges in rejection classification and prospects for adopting molecular pathology. Am J Transplant 2017;17:28-41
 


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Last Modified: 10/28/18 6:38 PM EDT