PUBLICATIONS

1
PUBLICATIONS

• Racusen/Solez meeting report for AJT.
• Manuscript on antibody-mediated rejection.
• Manuscript on recurrent autoimmune hepatitis.
• The editor of the Journal of Heart and Lung
  Transplantation (Dr. James Kirklin) requested a
  written set of suggestions from the Banff working
  group to be forwarded to the council of the
  International Society of Heart and Lung
  Transplantation

2
Criteria for Acute Antibody Mediated Rejection
(Provisional - Need 1, 2, and 3)

• 1. Morphologic evidence of acute tissue injury,
  such as a. acute tubular injury b. neutrophils
  and/or monos in PTC and/or glomeruli, or c.
  fibrinoid necrosis and transmural inflammation in
  arteries
• 2. Immunopathologic evidence for antibody action,
  such as a. C4d in PTC or b. Immunoglobulin and
  complement in fibrinoid necrosis
• 3. Serologic evidence of anti-HLA or other
  anti-donor antibodies .
• Comb. cellular and humoral rejection (see next)

3
Criteria for Acute Antibody Mediated Rejection

• Samples that meet the criteria for acute cellular
  rejection (Banff I and II) and have the criterion
  2 and 3 above are classified as combined cellular
  and humoral rejection.

4
Chronic Rejection Classification - Current Banff
97

• Chronic/Scleros. Allograft Nephropathy
• Grade I (mild) Mild interstitial fibrosis and
  tubular atrophy without (a) or with (b) specific
  changes suggesting chronic rejection
• Grade II Moderate interstitial fibrosis and
  tubular atrophy (moderate) (a) or (b)
• Grade III Severe interstitial fibrosis and
  tubular atrophy and tubular loss(severe) (a) or
  (b)

5
Chronic Rejection Classification - Current Banff
97 cont.

• Glomerular and vascular lesions help define
  type of chronic nephropathy chronic/recurrent
  rejection can be diagnosed if typical vascular
  lesions are seen.
• (Activity. - Immunologic and fibrotic activity
  indicators - C4D staining, and presence of
  mononuclear inflammatory cells in the fibrous
  arterial intima. PTC splitting and lamination
  have a significance similar to chronic transplant
  glomerulopathy. ? Role of collagen subtypes,
  smooth muscle cell actin,elastic tissue stains,
  molecular markers. Dan paragraph to come.)

6
Chronic Rejection Classification - Current Banff
97 cont.

• For studies at least two biopsies, more
  quantitation

7
Chronic Rejection Classification - Hope for the
Future after Studies Completed

• Chronic Allograft Dysfunction Classification1.
  No biopsy. Otherwise unexplained chronic
  progressive dysfunction.2. Biopsy.
  Uninstructive/Instructive specific - Acute
  rejection, recurrent disease, cyclosporine or FK
  toxicity, hypertensive vasc. disease or CAN (IF
  TA, FIT)(1-3) Nonimmunologic.Immunologic
  Changes - C4d, PTC splitting, Mihatsch light
  microscopic criteria