.The Banff Schemawas first developed by a group of pathologists, nephrologists, and transplant surgeons at a meeting in Banff Canada August 2-4, 1991.. It has continued to evolve through meetings every two years and has become the worldwide standard for interpretation of transplant biopsies.
A moderated self-organizing group to define and standardize organ allograft biopsy interpretation Aim is to promote international uniformity in reporting allograft pathology, which is necessary for research, clinical trials, and standardized patient management International and inter-disciplinary process with meetings every 2 years Mini-review “The Banff Classification Revisited” (Solez, K. and Racusen, L.C.) will be appearing in Kidney International later this year. Singularity Course
In 1990 all standard textbooks were inaccurate in interpretation of kidney transplant biopsies ◦ Suggesting, for example, that arteritis meant that the kidney was doomed and antirejection treatment should be abandoned It became imperative for the field to correct this and standardize interpretation Singularity Course
• Began in kidney (Solez et al. 1993), and was then extended to liver, pancreas, composite tissue grafts etc. Meetings also consider heart, lung, small bowel.• Uses semi-quantitative lesion scoring 0-3+ and diagnostic categories.
Normal Antibody-mediated rejection, Borderline changes: ‘Suspicious’ for acute cellular rejection T-cell-mediated rejection (may coincide with categories 2 and 5 and 6) Sclerosis, interstitial fibrosis, and tubular atrophy, no evidence of any specific etiology Other changes not considered to be due to rejection
Genome Canada transplant transcriptome project. Affymetrix GeneChip® probe array. Image courtesy of Affymetrix. Traditional pathology techniques.
1991 First Conference 1993 First Kidney International publication 1995 Integration with CADI 1997 Integration with CCTT classification 1999 Second KI paper. Clinical practice guidelines. Implantation biopsies, microwave. 2001 Classification of antibody-mediated rejection ◦ Regulatory agencies participating 2003 Genomics focus, ptc cell accumulation scoring 2005 Gene chip analysis. Elimination of CAN, identification of chronic antibody-mediated rejection. 2007 First meeting far from a town called “Banff” – La Coruna, Spain. 2009 Working groups. Meeting in Banff, Alberta, Canada for last time until 2015! Singularity Course
86% Kidney clinical6% Liver clinical Most articles are in high quality journals5% Kidney experimental with impact factor of 3.2 or higher,1% Liver experimental one third have impact factors of 6-9.
The Banff meeting reports and main meeting papers have been cited 4,312 times in the medical literature. The 1999 paper The Banff 97 Working Classification of Renal Allograft Pathology Kidney International 55(2):713-23, 1999 by Racusen, Solez, and Colvin et al. is a citation classic in the field having been cited 1,764 times. Singularity Course
Classification begun at 1991 Banff meeting has become the worldwide standard, and the consensus process has now extended to all solid organs. Future meetings are planned every two years through 2019. Standardization principles now being extended from biopsy reporting to tissue typing, imaging, all the other elements in transplant care. Classification used in clinical trials, and by the FDA, mandatory evaluation for drug approvals. Singularity Course
Banff Working Groups: Addressing unmet needs in a data-driven, evidence based approach Sis et al. 2009 Banff Meeting Report, Am J Transplant. 2010 Mar;10(3):464-71 Isolated v-lesion Working Group Fibrosis Scoring IHC Quality Assurance Working Group Working Group Data-driven & Validated Refinement of the Banff GuidelinesGlomerular Lesion Polyoma Virus Nephropathy Working Group Working Group C4d-Negative ABMR Working Group
Isolated V lesion – Banu Sis and Ed Kraus Fibrosis scoring – Robert Colvin Polyoma virus staging – Volker Nickeleit Glomerular lesion scoring – Mark Haas Molecular pathology – Phil Halloran Quality assurance IHC – Michael Mengel C4d neg. Ab-Mediated Rejection – Banu Sis History&Impact of Banff Process – Kim Solez Singularity Course
1.Defining appropriate thresholds for microvascular injury and for DSA that provide an optimal balance of specificity and sensitivity for ABMR, noting that none of these morphologic changes are specific and that not all patients with DSA have ABMR. 2. Defining "C4d-negative". There is some evidence that focal C4d is often (though less so than diffuse C4d) associated with DSA and microvascular injury. Singularity Course
3. Defining acute versus chronic/active Ab- mediated rejection. 4.Defining the significance of intimal arteritis (in the absence of necrosis) as histologic evidence for Ab-mediated rejection. Singularity Course
Includes analysis of physician facilitation of consensus discussions, seen most recently inBob Colvin’s C4d discussions and in Michael Mengel’s organization of Banff Working Groups. Also includes analysis of future trends and developments.
Future concepts of where technology is taking us are incorporated into long term planning of Banff Process. Will be part of 2013 meeting in Brazil.
• Until now we have had none beyond Drs. Racusen and Solez.• Will form Swiss foundation legal entity in 2012, to enable us to enter into formal relationships with other organizations we cannot do now.
To lead development and dissemination of the international Banff Classification of Allograft Pathology and to facilitate multidisciplinary, collaborative research to enhance its scientific basis and clinical utility to improve the care of transplant patients. Singularity Course
Facilitation of knowledge generation and translation in transplantation pathology with the ultimate aim to improve patient outcome Maintaining the Banff spirit of a multinational, multidisciplinary consensus group Fundraising Guidance and financial support for Working Group activities Guidance and financial support for Banff meetings activities Singularity Course
Responsible for annual reports of the Foundation and adherence to Swiss law Fiduciary responsibility for foundation funds Final responsibility for selection and content of Banff meetings Support and guide Working Group activities External representation of the Banff process: fundraising, policy papers, set up, content, and maintenance of a Banff website Bidirectional communication to membership of the Banff community Composition: ◦ The BOD consists of 6-9 members, including the Chair. ◦ Members are selected by majority vote of the BOD and serve for a 3 year term, renewable once. Terms are staggered (3 selected each year). ◦ The Chair and Secretary/Treasurer are selected by a majority vote of the BOD and serve for a 3 year term, renewable once. ◦ Vacancies filled by majority vote of BOD. Singularity Course
Secretary/Treasurer ◦ Responsible for day-to-day business/activities of the Banff Foundation and annual reporting ◦ Is a member of the board and regularly reports to the other board members ◦ Prepares annual budget and projections ◦ Monitors expenses ◦ Works closely with the administrative teamFlow and handling of funds through the A foundation should generate funding from whatever sources over its lifetime, to fulfil its purpose; which in this case would be to run Banff meetings and to foster advances organ transplantation Therefore the recommendation is to run any money e.g. from a pharmaceutical company into the Swiss Foundation, which then will at the Board of Trustees instruction transferred to a trusted organising committee, e.g. a University or Society account from local Banff meeting organizers , or Banff working group leaders for supporting their activities
Organization of meetings together with local organizers Organization of cross-organ plenary sessions Program finalization according to input from Organ Steering committees Selection of speakers and moderators Support and coordination of preparation of meeting reports Terms of references: ◦ Appointed by the BOD ◦ terms of membership four years (i.e. two meetings), renewable through majority vote of the board Singularity Course
Should engage pathologists and clinicians as well as representative from major geographic regions (e.g. North America, South America, Europe, Asia, Africa, Australia) Fund raising for the meetings and consensus work should also be scope for the organ steering committee members Organization of organ specific sessions: selection of topics and speakers Preparation of organ specific meeting reports Terms of reference: ◦ Leadership appointed by the board of directors for four years (i.e. two meetings), renewable through majority vote of the board ◦ Otherwise self-organized Singularity Course