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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