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Thrombotic Microangiopathy in the Renal Allograft: Results of the Tma Banff Working Group Consensus on Pathologic Diagnostic Criteria 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

Source: Transplant International Published:2023


Abstract

The Banff community summoned the TMA Banff Working Group to develop minimum diagnostic criteria (MDC) and recommendations for renal transplant TMA (Tx-TMA) diagnosis, which currently lacks standardized criteria. Using the Delphi method for consensus generation, 23 nephropathologists (panelists) with >3 years of diagnostic experience with Tx-TMA were asked to list light, immunofluorescence, and electron microscopic, clinical and laboratory criteria and differential diagnoses for Tx-TMA. Delphi was modified to include 2 validations rounds with histological evaluation of whole slide images of 37 transplant biopsies (28 TMA and 9 non-TMA). Starting with 338 criteria in R1, MDC were narrowed down to 24 in R8 generating 18 pathological, 2 clinical, 4 laboratory criteria, and 8 differential diagnoses. The panelists reached a good level of agreement (70%) on 76% of the validated cases. For the first time in Banff classification, Delphi was used to reach consensus on MDC for Tx-TMA. Phase I of the study (pathology phase) will be used as a model for Phase II (nephrology phase) for consensus regarding clinical and laboratory criteria. Eventually in Phase III (consensus of the consensus groups) and the final MDC for Tx-TMA will be reported to the transplantation community. 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.
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