Nephrology Dialysis Transplantation, Vol 12, Issue 5 995-1000, Copyright © 1997 by Oxford University Press
P Furness, U Kirkpatrick, N Taub, D Davies and K Solez
Background. The Banff classification of renal
transplant pathology has gained wide support since its introduction in
1993. There have been several studies which have tested its usefulness in
the context of research-oriented centres. We sought to evaluate its use in
a wider context. Methods. We recruited pathologists
from all but one of the renal transplant centres in the UK. Sections were
circulated from 21 selected 'difficult' cases, in all of which the clinical
question was confirmation or exclusion of acute rejection, and in all of
which a definite diagnosis had been obvious from the subsequent clinical
course. Participants were asked first to diagnose or exclude acute
rejection by their usual approach, then to apply the Banff classification.
No clinical information was given beyond the time since engraftment, in
order to confine the evaluation to the morphological features present in
the sections. At the end of the study the subjective impressions of the
participants were sought using a structured questionnaire.
Results. Using the Banff classification produced no
detectable difference in the number of 'correct' diagnoses when compared
with a conventional approach, irrespective of whether the 'correct'
diagnosis is based on retrospective clinical information or on the
consensus opinion of the pathologists involved, and irrespective of where
in the Banff schema one applies a 'cut-off' for the diagnosis of acute
rejection. However, the reproducibility of the diagnoses was improved. The
results suggest that in the Banff classification the best 'cut-off' point
for the diagnosis of acute rejection is between Banff category 3 and
category 4, although in this difficult area we found a large improvement in
diagnostic accuracy if input of clinical information occurs.
Conclusions. The improved reproducibility justifies
the use of the Banff classification to harmonise approaches between
centres, especially in research projects. While there are good reasons also
to adopt it in routine diagnostic practice, further refinement is necessary
before an improvement in the accuracy of diagnosis can be demonstrated.
Keywords: transplant; graft; renal; histopathology;
diagnosis; rejection; Banff
ORIGINAL ARTICLES
A UK-wide trial of the Banff classification of renal transplant pathology in routine diagnostic practice
Department of Pathology and Department of Surgery, Leicester General Hospital, Leicester, UK; Department of Epidemiology and Public Health, University of Leicester, Leicester, UK; Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK; Department of Laboratory Medicine and Pathology, University Alberta, Canada; Correspondence to PN Furness, Department of Pathology, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
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