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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
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. Department of Nephrology, Ludwig Maximilian University, Munich, Germany
  5. 5. Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
  6. 6. Department of Pathology, The Houston Methodist Hospital, Houston, TX, United States
  7. 7. Laboratory Medicine Program, 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 of Experimental Medicine and Systems Biology, RWTH Aachen University, Aachen, Germany
  16. 16. Departamento de Parasitologia, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  17. 17. Department of Pathology, School of Medicine, Koc University, Sariyer, Turkey
  18. 18. Department of Anatomical Pathology, NSW Health Pathology, Callaghan, NSW, Australia
  19. 19. School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
  20. 20. Department of Pathology, School of Medicine, University of Zagreb, Zagreb, Croatia
  21. 21. Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, United States
  22. 22. AeskuLab Pathology and 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 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 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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