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Authors Drachenberg CB, Torrealba JR, Nankivell BJ, Rangel EB, Bajema IM, Kim DU, Arend L, Bracamonte ER, Bromberg JS, Bruijn JA, Cantarovich D, Chapman JR, Farris AB, Gaber L, Goldberg JC, Haririan A, Honsová E, Iskandar SS, Klassen DK, Kraus E, Lower F, Odorico J, Olson JL, Mittalhenkle A, Munivenkatappa R, Paraskevas S, Papadimitriou JC, Randhawa P, Reinholt FP, Renaudin K, Revelo P, Ruiz P, Samaniego MD, Shapiro R, Stratta RJ, Sutherland DE, Troxell ML, Voska L, Seshan SV, Racusen LC, Bartlett ST
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Journal Am. J. Transplant. Volume: 11 Issue: 9 Pages: 1792-802
Publish Date 2011 Sep
PubMed ID 21812920
Abstract

The first Banff proposal for the diagnosis of pancreas rejection (Am J Transplant 2008; 8: 237) dealt primarily with the diagnosis of acute T-cell-mediated rejection (ACMR), while only tentatively addressing issues pertaining to antibody-mediated rejection (AMR). This document presents comprehensive guidelines for the diagnosis of AMR, first proposed at the 10th Banff Conference on Allograft Pathology and refined by a broad-based multidisciplinary panel. Pancreatic AMR is best identified by a combination of serological and immunohistopathological findings consisting of (i) identification of circulating donor-specific antibodies, and histopathological data including (ii) morphological evidence of microvascular tissue injury and (iii) C4d staining in interacinar capillaries. Acute AMR is diagnosed conclusively if these three elements are present, whereas a diagnosis of suspicious for AMR is rendered if only two elements are identified. The identification of only one diagnostic element is not sufficient for the diagnosis of AMR but should prompt heightened clinical vigilance. AMR and ACMR may coexist, and should be recognized and graded independently. This proposal is based on our current knowledge of the pathogenesis of pancreas rejection and currently available tools for diagnosis. A systematized clinicopathological approach to AMR is essential for the development and assessment of much needed therapeutic interventions.

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