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Delphi: A Democratic and Cost-Effective Method of Consensus Generation in Transplantation Publisher Pubmed



Afrouzian M1 ; Kozakowski N2 ; Liapis H3, 4 ; Broecker V5 ; Truong L6 ; Avilacasado C7 ; Regele H2 ; Seshan S8 ; Ambruzs JM9 ; Farris AB10 ; Buob D11 ; Chander PN12 ; Cheraghvandi L13 ; Clahsenvan Groningen MC14, 15 Show All Authors
Authors
  1. Afrouzian M1
  2. Kozakowski N2
  3. Liapis H3, 4
  4. Broecker V5
  5. Truong L6
  6. Avilacasado C7
  7. Regele H2
  8. Seshan S8
  9. Ambruzs JM9
  10. Farris AB10
  11. Buob D11
  12. Chander PN12
  13. Cheraghvandi L13
  14. Clahsenvan Groningen MC14, 15
  15. De Almeida Araujo S16
  16. Ertoy Baydar D17
  17. Formby M18, 19
  18. Galesic Ljubanovic D20
  19. Herrera Hernandez L21
  20. Honsova E22
  21. Mohamed N23
  22. Ozluk Y24
  23. Rabant M25
  24. Royal V26
  25. Stevenson HL1
  26. Toniolo MF27
  27. Taheri D28
Show Affiliations
Authors Affiliations
  1. 1. Department of Pathology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
  2. 2. Department of Pathology, Medical University of Vienna, Vienna, Austria
  3. 3. Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
  4. 4. GeoBio-Center, Ludwig Maximilian University of Munich, Munich, Germany
  5. 5. Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
  6. 6. Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, United States
  7. 7. Krembil Brain Institute, University Health Network (UHN), Toronto, ON, Canada
  8. 8. Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States
  9. 9. Arkana Laboratories, Little Rock, AR, United States
  10. 10. Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
  11. 11. Department of Pathology, Universite de Sorbonne, Assistance Publique—Hopitaux de Paris, Hopital Tenon, Paris, France
  12. 12. New York Medical College, Valhalla, NY, United States
  13. 13. Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, United States
  14. 14. Department of Pathology and Clinical Bioinformatics, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
  15. 15. Institute for Cell and Tumor Biology, University Hospital RWTH Aachen, Aachen, Germany
  16. 16. Departamento de Patologia Geral, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  17. 17. Department of Neurology, School of Medicine, Koc University, Istanbul, Turkey
  18. 18. Department of Anatomical Pathology, NSW Health Pathology, Callaghan, NSW, Australia
  19. 19. School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
  20. 20. Department of Pathology, School of Medicine, University of Zagreb, Zagreb, Croatia
  21. 21. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
  22. 22. AeskuLab Pathology, Department of Pathology, Charles University, Prague, Czech Republic
  23. 23. Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
  24. 24. Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
  25. 25. Department of Pathology, Necker-Enfants Malades Hospital, Universite de Paris Cite, Paris, France
  26. 26. Department of Pathology, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada
  27. 27. Kidney Pancreas Transplantation, Instituto de Nefrologia-Nephrology, Buenos Aires, Argentina
  28. 28. Department of Pathology, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Source: Transplant International Published:2023


Abstract

The Thrombotic Microangiopathy Banff Working Group (TMA-BWG) was formed in 2015 to survey current practices and develop minimum diagnostic criteria (MDC) for renal transplant TMA (Tx-TMA). To generate consensus among pathologists and nephrologists, the TMA BWG designed a 3-Phase study. Phase I of the study is presented here. Using the Delphi methodology, 23 panelists with >3 years of diagnostic experience with Tx-TMA pathology listed their MDC suggesting light, immunofluorescence, and electron microscopy lesions, clinical and laboratory information, and differential diagnoses. Nine rounds (R) of consensus resulted in MDC validated during two Rs using online evaluation of whole slide digital images of 37 biopsies (28 TMA, 9 non-TMA). Starting with 338 criteria the process resulted in 24 criteria and 8 differential diagnoses including 18 pathologic, 2 clinical, and 4 laboratory criteria. Results show that 3/4 of the panelists agreed on the diagnosis of 3/4 of cases. The process also allowed definition refinement for 4 light and 4 electron microscopy lesions. For the first time in Banff classification, the Delphi methodology was used to generate consensus. The study shows that Delphi is a democratic and cost-effective method allowing rapid consensus generation among numerous physicians dealing with large number of criteria in transplantation. Copyright © 2023 Afrouzian, Kozakowski, Liapis, Broecker, Truong, Avila-Casado, Regele, Seshan, Ambruzs, Farris, Buob, Chander, Cheraghvandi, Clahsen-van Groningen, de Almeida Araujo, Ertoy Baydar, Formby, Galesic Ljubanovic, Herrera Hernandez, Honsova, Mohamed, Ozluk, Rabant, Royal, Stevenson, Toniolo and Taheri.