Transplantationstechnologien und Forschung

Evolution of the Banff Working Classification of Renal Allograft Pathology: Updates and Future Directions

Abstract

Muhammed Mubarak

Renal transplant pathology is a complex and rapidly evolving field of surgical pathology and the pathologic interpretation of renal allograft biopsy pose significant challenges and opportunities to the renal transplant pathologists. Both allo-immune and non-immune factors often interplay in causing damage to the kidney allograft at different time intervals post-transplantation. An accurate identification of these etiologic factors is essential for the optimal management and better long-term outcome of the renal transplant patients and the biopsy plays a pivotal role in this process. The Banff classification was introduced as an international, consensus-based working formulation to harmonize the reporting of pathological lesions seen on renal allograft biopsies. The first meeting of the Banff group took place in 1991 and the first detailed publication on the classification appeared in 1993. Subsequent meetings have been held regularly every two years with regular updates, additions and revisions of the original classification. The latest meeting was held in Brazil this year (2013) and its detailed reporting is still due.

This editorial attempts to summarize the main changes that have taken place in the interpretation of renal allograft biopsy pathology and the Banff classification over the last two decades. The main focus of the paper will be on the evolution of the morphological and immunohistochemical changes, as these are still the mainstay of the Banff classification. The standardization and incorporation of the formal morphometric and molecular data into the Banff classification for practical use is still a challenge for the future.