Banff survey on antibody-mediated rejection clinical practices in kidney transplantation

Diagnostic misinterpretation has potential therapeutic implications

Carrie Schinstock, Ruth Sapir-Pichhadze, Maarten Naesens, Ibrahim Batal, Serena Bagnasco, Laurine Bow, Patricia Campbell, Marian C. Clahsen-van Groningen, Matthew Cooper, Emanuele Cozzi, Darshana Dadhania, Fritz Diekmann, Klemens Budde, Fritz Lower, Babak J. Orandi, Ajda T. Rowshani, Lynn Cornell, Edward Kraus

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

The aim of this study was to determine how the Banff antibody-mediated rejection (ABMR) classification for kidney transplantation is interpreted in practice and affects therapy. The Banff Antibody-Mediated Injury Workgroup electronically surveyed clinicians and pathologists worldwide regarding diagnosis and treatment for 6 case-based scenarios. The participants' (95 clinicians and 72 renal pathologists) assigned diagnoses were compared to the Banff intended diagnoses (reference standard). The assigned diagnoses and reference standard differed by 26.1% (SD 28.1%) for pathologists and 34.5% (SD 23.3%) for clinicians. The greatest discordance between the reference standard and clinicians' diagnosis was when histologic features of ABMR were present but donor-specific antibody was undetected (49.4% [43/87]). For pathologists, the greatest discordance was in the case of acute/active ABMR C4d staining negative in a positive crossmatch transplant recipient (33.8% [23/68]). Treatment approaches were heterogeneous but linked to the assigned diagnosis. When acute/active ABMR was diagnosed by the clinician, treatment was recommended 95.3% (SD 18.4%) of the time vs only 77.7% (SD 39.2%) of the time when chronic active ABMR was diagnosed (P < .0001). In conclusion, the Banff ABMR classification is vulnerable to misinterpretation, which potentially has patient management implications. Continued efforts are needed to improve the understanding and standardized application of ABMR classification in the transplant community.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Kidney Transplantation
Antibodies
Therapeutics
Surveys and Questionnaires
Negative Staining
Tissue Donors
Transplants
Kidney
Pathologists
Wounds and Injuries

Keywords

  • Classification systems: Banff classification
  • Clinical decision making
  • Clinical research/practice
  • Kidney transplantation/nephrology
  • Rejection: antibody-mediated (ABMR)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Banff survey on antibody-mediated rejection clinical practices in kidney transplantation : Diagnostic misinterpretation has potential therapeutic implications. / Schinstock, Carrie; Sapir-Pichhadze, Ruth; Naesens, Maarten; Batal, Ibrahim; Bagnasco, Serena; Bow, Laurine; Campbell, Patricia; Clahsen-van Groningen, Marian C.; Cooper, Matthew; Cozzi, Emanuele; Dadhania, Darshana; Diekmann, Fritz; Budde, Klemens; Lower, Fritz; Orandi, Babak J.; Rowshani, Ajda T.; Cornell, Lynn; Kraus, Edward.

In: American Journal of Transplantation, 01.01.2018.

Research output: Contribution to journalArticle

Schinstock, C, Sapir-Pichhadze, R, Naesens, M, Batal, I, Bagnasco, S, Bow, L, Campbell, P, Clahsen-van Groningen, MC, Cooper, M, Cozzi, E, Dadhania, D, Diekmann, F, Budde, K, Lower, F, Orandi, BJ, Rowshani, AT, Cornell, L & Kraus, E 2018, 'Banff survey on antibody-mediated rejection clinical practices in kidney transplantation: Diagnostic misinterpretation has potential therapeutic implications', American Journal of Transplantation. https://doi.org/10.1111/ajt.14979
Schinstock, Carrie ; Sapir-Pichhadze, Ruth ; Naesens, Maarten ; Batal, Ibrahim ; Bagnasco, Serena ; Bow, Laurine ; Campbell, Patricia ; Clahsen-van Groningen, Marian C. ; Cooper, Matthew ; Cozzi, Emanuele ; Dadhania, Darshana ; Diekmann, Fritz ; Budde, Klemens ; Lower, Fritz ; Orandi, Babak J. ; Rowshani, Ajda T. ; Cornell, Lynn ; Kraus, Edward. / Banff survey on antibody-mediated rejection clinical practices in kidney transplantation : Diagnostic misinterpretation has potential therapeutic implications. In: American Journal of Transplantation. 2018.
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abstract = "The aim of this study was to determine how the Banff antibody-mediated rejection (ABMR) classification for kidney transplantation is interpreted in practice and affects therapy. The Banff Antibody-Mediated Injury Workgroup electronically surveyed clinicians and pathologists worldwide regarding diagnosis and treatment for 6 case-based scenarios. The participants' (95 clinicians and 72 renal pathologists) assigned diagnoses were compared to the Banff intended diagnoses (reference standard). The assigned diagnoses and reference standard differed by 26.1{\%} (SD 28.1{\%}) for pathologists and 34.5{\%} (SD 23.3{\%}) for clinicians. The greatest discordance between the reference standard and clinicians' diagnosis was when histologic features of ABMR were present but donor-specific antibody was undetected (49.4{\%} [43/87]). For pathologists, the greatest discordance was in the case of acute/active ABMR C4d staining negative in a positive crossmatch transplant recipient (33.8{\%} [23/68]). Treatment approaches were heterogeneous but linked to the assigned diagnosis. When acute/active ABMR was diagnosed by the clinician, treatment was recommended 95.3{\%} (SD 18.4{\%}) of the time vs only 77.7{\%} (SD 39.2{\%}) of the time when chronic active ABMR was diagnosed (P < .0001). In conclusion, the Banff ABMR classification is vulnerable to misinterpretation, which potentially has patient management implications. Continued efforts are needed to improve the understanding and standardized application of ABMR classification in the transplant community.",
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AU - Sapir-Pichhadze, Ruth

AU - Naesens, Maarten

AU - Batal, Ibrahim

AU - Bagnasco, Serena

AU - Bow, Laurine

AU - Campbell, Patricia

AU - Clahsen-van Groningen, Marian C.

AU - Cooper, Matthew

AU - Cozzi, Emanuele

AU - Dadhania, Darshana

AU - Diekmann, Fritz

AU - Budde, Klemens

AU - Lower, Fritz

AU - Orandi, Babak J.

AU - Rowshani, Ajda T.

AU - Cornell, Lynn

AU - Kraus, Edward

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AB - The aim of this study was to determine how the Banff antibody-mediated rejection (ABMR) classification for kidney transplantation is interpreted in practice and affects therapy. The Banff Antibody-Mediated Injury Workgroup electronically surveyed clinicians and pathologists worldwide regarding diagnosis and treatment for 6 case-based scenarios. The participants' (95 clinicians and 72 renal pathologists) assigned diagnoses were compared to the Banff intended diagnoses (reference standard). The assigned diagnoses and reference standard differed by 26.1% (SD 28.1%) for pathologists and 34.5% (SD 23.3%) for clinicians. The greatest discordance between the reference standard and clinicians' diagnosis was when histologic features of ABMR were present but donor-specific antibody was undetected (49.4% [43/87]). For pathologists, the greatest discordance was in the case of acute/active ABMR C4d staining negative in a positive crossmatch transplant recipient (33.8% [23/68]). Treatment approaches were heterogeneous but linked to the assigned diagnosis. When acute/active ABMR was diagnosed by the clinician, treatment was recommended 95.3% (SD 18.4%) of the time vs only 77.7% (SD 39.2%) of the time when chronic active ABMR was diagnosed (P < .0001). In conclusion, the Banff ABMR classification is vulnerable to misinterpretation, which potentially has patient management implications. Continued efforts are needed to improve the understanding and standardized application of ABMR classification in the transplant community.

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