Guidelines for the diagnosis of antibody-mediated rejection in pancreas allografts-updated Banff grading schema

Cinthia B. Drachenberg; J. R. Torrealba; B. J. Nankivell; E. B. Rangel; I. M. Bajema; D. U. Kim; L. Arend; E. R. Bracamonte; J. S. Bromberg; J. A. Bruijn; D. Cantarovich; J. R. Chapman; A. B. Farris; L. Gaber; J. C. Goldberg; A. Haririan; E. Honsová; S. S. Iskandar; D. K. Klassen; E. Kraus; F. Lower; J. Odorico; J. L. Olson; A. Mittalhenkle; R. Munivenkatappa; S. Paraskevas; J. C. Papadimitriou; P. Randhawa; F. P. Reinholt; K. Renaudin; P. Revelo; P. Ruiz; M. D. Samaniego; R. Shapiro; R. J. Stratta; D. E R Sutherland; M. L. Troxell; L. Voska; S. V. Seshan; L. C. Racusen; S. T. Bartlett

doi:10.1111/j.1600-6143.2011.03670.x

Guidelines for the diagnosis of antibody-mediated rejection in pancreas allografts-updated Banff grading schema

Cinthia B. Drachenberg, J. R. Torrealba, B. J. Nankivell, E. B. Rangel, I. M. Bajema, D. U. Kim, L. Arend, E. R. Bracamonte, J. S. Bromberg, J. A. Bruijn, D. Cantarovich, J. R. Chapman, A. B. Farris, L. Gaber, J. C. Goldberg, A. Haririan, E. Honsová, S. S. Iskandar, D. K. Klassen, E. KrausF. Lower, J. Odorico, J. L. Olson, A. Mittalhenkle, R. Munivenkatappa, S. Paraskevas, J. C. Papadimitriou, P. Randhawa, F. P. Reinholt, K. Renaudin, P. Revelo, P. Ruiz, M. D. Samaniego, R. Shapiro, R. J. Stratta, D. E R Sutherland, M. L. Troxell, L. Voska, S. V. Seshan, L. C. Racusen, S. T. Bartlett

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102 Scopus citations

Abstract

The first Banff proposal for the diagnosis of pancreas rejection (Am J Transplant 2008; 8: 237) dealt primarily with the diagnosis of acute T-cell-mediated rejection (ACMR), while only tentatively addressing issues pertaining to antibody-mediated rejection (AMR). This document presents comprehensive guidelines for the diagnosis of AMR, first proposed at the 10th Banff Conference on Allograft Pathology and refined by a broad-based multidisciplinary panel. Pancreatic AMR is best identified by a combination of serological and immunohistopathological findings consisting of (i) identification of circulating donor-specific antibodies, and histopathological data including (ii) morphological evidence of microvascular tissue injury and (iii) C4d staining in interacinar capillaries. Acute AMR is diagnosed conclusively if these three elements are present, whereas a diagnosis of suspicious for AMR is rendered if only two elements are identified. The identification of only one diagnostic element is not sufficient for the diagnosis of AMR but should prompt heightened clinical vigilance. AMR and ACMR may coexist, and should be recognized and graded independently. This proposal is based on our current knowledge of the pathogenesis of pancreas rejection and currently available tools for diagnosis. A systematized clinicopathological approach to AMR is essential for the development and assessment of much needed therapeutic interventions.

Original language	English (US)
Pages (from-to)	1792-1802
Number of pages	11
Journal	American Journal of Transplantation
Volume	11
Issue number	9
DOIs	https://doi.org/10.1111/j.1600-6143.2011.03670.x
State	Published - Sep 2011

Keywords

Acinar cell injury
C4d
active chronic antibody-mediated rejection
amylin
amyloid
cell-mediated rejection
donor-specific antibody
interacinar capillaries
pancreas biopsy
transplant arteriopathy

ASJC Scopus subject areas

Immunology and Allergy
Transplantation
Pharmacology (medical)

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10.1111/j.1600-6143.2011.03670.x

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Drachenberg, C. B., Torrealba, J. R., Nankivell, B. J., Rangel, E. B., Bajema, I. M., Kim, D. U., Arend, L., Bracamonte, E. R., Bromberg, J. S., Bruijn, J. A., Cantarovich, D., Chapman, J. R., Farris, A. B., Gaber, L., Goldberg, J. C., Haririan, A., Honsová, E., Iskandar, S. S., Klassen, D. K., ... Bartlett, S. T. (2011). Guidelines for the diagnosis of antibody-mediated rejection in pancreas allografts-updated Banff grading schema. American Journal of Transplantation, 11(9), 1792-1802. https://doi.org/10.1111/j.1600-6143.2011.03670.x

Drachenberg, CB, Torrealba, JR, Nankivell, BJ, Rangel, EB, Bajema, IM, Kim, DU, Arend, L, Bracamonte, ER, Bromberg, JS, Bruijn, JA, Cantarovich, D, Chapman, JR, Farris, AB, Gaber, L, Goldberg, JC, Haririan, A, Honsová, E, Iskandar, SS, Klassen, DK, Kraus, E, Lower, F, Odorico, J, Olson, JL, Mittalhenkle, A, Munivenkatappa, R, Paraskevas, S, Papadimitriou, JC, Randhawa, P, Reinholt, FP, Renaudin, K, Revelo, P, Ruiz, P, Samaniego, MD, Shapiro, R, Stratta, RJ, Sutherland, DER, Troxell, ML, Voska, L, Seshan, SV, Racusen, LC & Bartlett, ST 2011, 'Guidelines for the diagnosis of antibody-mediated rejection in pancreas allografts-updated Banff grading schema', American Journal of Transplantation, vol. 11, no. 9, pp. 1792-1802. https://doi.org/10.1111/j.1600-6143.2011.03670.x

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title = "Guidelines for the diagnosis of antibody-mediated rejection in pancreas allografts-updated Banff grading schema",

abstract = "The first Banff proposal for the diagnosis of pancreas rejection (Am J Transplant 2008; 8: 237) dealt primarily with the diagnosis of acute T-cell-mediated rejection (ACMR), while only tentatively addressing issues pertaining to antibody-mediated rejection (AMR). This document presents comprehensive guidelines for the diagnosis of AMR, first proposed at the 10th Banff Conference on Allograft Pathology and refined by a broad-based multidisciplinary panel. Pancreatic AMR is best identified by a combination of serological and immunohistopathological findings consisting of (i) identification of circulating donor-specific antibodies, and histopathological data including (ii) morphological evidence of microvascular tissue injury and (iii) C4d staining in interacinar capillaries. Acute AMR is diagnosed conclusively if these three elements are present, whereas a diagnosis of suspicious for AMR is rendered if only two elements are identified. The identification of only one diagnostic element is not sufficient for the diagnosis of AMR but should prompt heightened clinical vigilance. AMR and ACMR may coexist, and should be recognized and graded independently. This proposal is based on our current knowledge of the pathogenesis of pancreas rejection and currently available tools for diagnosis. A systematized clinicopathological approach to AMR is essential for the development and assessment of much needed therapeutic interventions.",

keywords = "Acinar cell injury, C4d, active chronic antibody-mediated rejection, amylin, amyloid, cell-mediated rejection, donor-specific antibody, interacinar capillaries, pancreas biopsy, transplant arteriopathy",

author = "Drachenberg, {Cinthia B.} and Torrealba, {J. R.} and Nankivell, {B. J.} and Rangel, {E. B.} and Bajema, {I. M.} and Kim, {D. U.} and L. Arend and Bracamonte, {E. R.} and Bromberg, {J. S.} and Bruijn, {J. A.} and D. Cantarovich and Chapman, {J. R.} and Farris, {A. B.} and L. Gaber and Goldberg, {J. C.} and A. Haririan and E. Honsov{\'a} and Iskandar, {S. S.} and Klassen, {D. K.} and E. Kraus and F. Lower and J. Odorico and Olson, {J. L.} and A. Mittalhenkle and R. Munivenkatappa and S. Paraskevas and Papadimitriou, {J. C.} and P. Randhawa and Reinholt, {F. P.} and K. Renaudin and P. Revelo and P. Ruiz and Samaniego, {M. D.} and R. Shapiro and Stratta, {R. J.} and Sutherland, {D. E R} and Troxell, {M. L.} and L. Voska and Seshan, {S. V.} and Racusen, {L. C.} and Bartlett, {S. T.}",

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doi = "10.1111/j.1600-6143.2011.03670.x",

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T1 - Guidelines for the diagnosis of antibody-mediated rejection in pancreas allografts-updated Banff grading schema

AU - Drachenberg, Cinthia B.

AU - Torrealba, J. R.

AU - Nankivell, B. J.

AU - Rangel, E. B.

AU - Bajema, I. M.

AU - Kim, D. U.

AU - Arend, L.

AU - Bracamonte, E. R.

AU - Bromberg, J. S.

AU - Bruijn, J. A.

AU - Cantarovich, D.

AU - Chapman, J. R.

AU - Farris, A. B.

AU - Gaber, L.

AU - Goldberg, J. C.

AU - Haririan, A.

AU - Honsová, E.

AU - Iskandar, S. S.

AU - Klassen, D. K.

AU - Kraus, E.

AU - Lower, F.

AU - Odorico, J.

AU - Olson, J. L.

AU - Mittalhenkle, A.

AU - Munivenkatappa, R.

AU - Paraskevas, S.

AU - Papadimitriou, J. C.

AU - Randhawa, P.

AU - Reinholt, F. P.

AU - Renaudin, K.

AU - Revelo, P.

AU - Ruiz, P.

AU - Samaniego, M. D.

AU - Shapiro, R.

AU - Stratta, R. J.

AU - Sutherland, D. E R

AU - Troxell, M. L.

AU - Voska, L.

AU - Seshan, S. V.

AU - Racusen, L. C.

AU - Bartlett, S. T.

PY - 2011/9

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N2 - The first Banff proposal for the diagnosis of pancreas rejection (Am J Transplant 2008; 8: 237) dealt primarily with the diagnosis of acute T-cell-mediated rejection (ACMR), while only tentatively addressing issues pertaining to antibody-mediated rejection (AMR). This document presents comprehensive guidelines for the diagnosis of AMR, first proposed at the 10th Banff Conference on Allograft Pathology and refined by a broad-based multidisciplinary panel. Pancreatic AMR is best identified by a combination of serological and immunohistopathological findings consisting of (i) identification of circulating donor-specific antibodies, and histopathological data including (ii) morphological evidence of microvascular tissue injury and (iii) C4d staining in interacinar capillaries. Acute AMR is diagnosed conclusively if these three elements are present, whereas a diagnosis of suspicious for AMR is rendered if only two elements are identified. The identification of only one diagnostic element is not sufficient for the diagnosis of AMR but should prompt heightened clinical vigilance. AMR and ACMR may coexist, and should be recognized and graded independently. This proposal is based on our current knowledge of the pathogenesis of pancreas rejection and currently available tools for diagnosis. A systematized clinicopathological approach to AMR is essential for the development and assessment of much needed therapeutic interventions.

AB - The first Banff proposal for the diagnosis of pancreas rejection (Am J Transplant 2008; 8: 237) dealt primarily with the diagnosis of acute T-cell-mediated rejection (ACMR), while only tentatively addressing issues pertaining to antibody-mediated rejection (AMR). This document presents comprehensive guidelines for the diagnosis of AMR, first proposed at the 10th Banff Conference on Allograft Pathology and refined by a broad-based multidisciplinary panel. Pancreatic AMR is best identified by a combination of serological and immunohistopathological findings consisting of (i) identification of circulating donor-specific antibodies, and histopathological data including (ii) morphological evidence of microvascular tissue injury and (iii) C4d staining in interacinar capillaries. Acute AMR is diagnosed conclusively if these three elements are present, whereas a diagnosis of suspicious for AMR is rendered if only two elements are identified. The identification of only one diagnostic element is not sufficient for the diagnosis of AMR but should prompt heightened clinical vigilance. AMR and ACMR may coexist, and should be recognized and graded independently. This proposal is based on our current knowledge of the pathogenesis of pancreas rejection and currently available tools for diagnosis. A systematized clinicopathological approach to AMR is essential for the development and assessment of much needed therapeutic interventions.

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KW - active chronic antibody-mediated rejection

KW - amylin

KW - amyloid

KW - cell-mediated rejection

KW - donor-specific antibody

KW - interacinar capillaries

KW - pancreas biopsy

KW - transplant arteriopathy

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Guidelines for the diagnosis of antibody-mediated rejection in pancreas allografts-updated Banff grading schema

Abstract

Keywords

ASJC Scopus subject areas

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