TY - JOUR
T1 - Banff survey on antibody-mediated rejection clinical practices in kidney transplantation
T2 - Diagnostic misinterpretation has potential therapeutic implications
AU - Schinstock, Carrie A.
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
N1 - Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2019/1
Y1 - 2019/1
N2 - 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.
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.
KW - classification systems: Banff classification
KW - clinical decision making
KW - clinical research/practice
KW - kidney transplantation/nephrology
KW - rejection: antibody-mediated (ABMR)
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U2 - 10.1111/ajt.14979
DO - 10.1111/ajt.14979
M3 - Article
C2 - 29935060
AN - SCOPUS:85050618725
SN - 1600-6135
VL - 19
SP - 123
EP - 131
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 1
ER -