Banff survey on antibody‐mediated rejection clinical practices in kidney transplantation: Diagnostic misinterpretation has potential therapeutic implications

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 diagn...

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Bibliographic Details
Published in:American journal of transplantation 2019-01, Vol.19 (1), p.123-131
Main Authors: Schinstock, Carrie A., 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
Format: Article
Language:English
Subjects:
Allografts
Blood Grouping and Crossmatching
Classification
classification systems: Banff classification
Clinical decision making
clinical research/practice
Complement C4b
Diagnosis
Diagnostic Errors
Discordance
Graft rejection
Graft Rejection - diagnosis
Histocompatibility testing
Humans
International Cooperation
Isoantibodies
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - surgery
Kidney Transplantation
kidney transplantation/nephrology
Kidney transplants
Medical diagnosis
Nephrology - standards
Observer Variation
Pathology - standards
Peptide Fragments - blood
Prognosis
Reference Standards
rejection: antibody‐mediated (ABMR)
Reproducibility of Results
Surveys and Questionnaires
Terminology as Topic
Transplants & implants
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Summary: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 
ISSN:1600-6135
1600-6143
DOI:10.1111/ajt.14979