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 & 21 others 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, Phillip 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

Research output: Contribution to journalArticle

63 Citations (Scopus)

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 languageEnglish
Pages (from-to)1792-1802
Number of pages11
JournalAmerican Journal of Transplantation
Volume11
Issue number9
DOIs
StatePublished - Sep 1 2011

Fingerprint

Allografts
Pancreas
Guidelines
Antibodies
T-Lymphocytes
Pathology
Staining and Labeling
Transplants
Wounds and Injuries

Keywords

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

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Drachenberg, C. B., Torrealba, J. R., Nankivell, B. J., Rangel, E. B., Bajema, I. M., Kim, D. U., ... 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

Guidelines for the diagnosis of antibody-mediated rejection in pancreas allografts-updated Banff grading schema. / Drachenberg, Cinthia 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.; Kraus, E.; Lower, F.; Odorico, J.; Olson, J. L.; Mittalhenkle, A.; Munivenkatappa, R.; Paraskevas, S.; Papadimitriou, J. C.; Randhawa, P.; Reinholt, F. P.; Renaudin, K.; Revelo, P.; Ruiz, Phillip; Samaniego, M. D.; Shapiro, R.; Stratta, R. J.; Sutherland, D. E R; Troxell, M. L.; Voska, L.; Seshan, S. V.; Racusen, L. C.; Bartlett, S. T.

In: American Journal of Transplantation, Vol. 11, No. 9, 01.09.2011, p. 1792-1802.

Research output: Contribution to journalArticle

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
Drachenberg, Cinthia 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. ; Kraus, E. ; Lower, F. ; Odorico, J. ; Olson, J. L. ; Mittalhenkle, A. ; Munivenkatappa, R. ; Paraskevas, S. ; Papadimitriou, J. C. ; Randhawa, P. ; Reinholt, F. P. ; Renaudin, K. ; Revelo, P. ; Ruiz, Phillip ; Samaniego, M. D. ; Shapiro, R. ; Stratta, R. J. ; Sutherland, D. E R ; Troxell, M. L. ; Voska, L. ; Seshan, S. V. ; Racusen, L. C. ; Bartlett, S. T. / Guidelines for the diagnosis of antibody-mediated rejection in pancreas allografts-updated Banff grading schema. In: American Journal of Transplantation. 2011 ; Vol. 11, No. 9. pp. 1792-1802.
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AU - Bajema, I. M.

AU - Kim, D. U.

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AU - Reinholt, F. P.

AU - Renaudin, K.

AU - Revelo, P.

AU - Ruiz, Phillip

AU - Samaniego, M. D.

AU - Shapiro, R.

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