Transplant International (Aug 2023)

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

  • Marjan Afrouzian,
  • Nicolas Kozakowski,
  • Helen Liapis,
  • Verena Broecker,
  • Luon Truong,
  • Carmen Avila-Casado,
  • Heinz Regele,
  • Surya Seshan,
  • Josephine M. Ambruzs,
  • Alton Brad Farris,
  • David Buob,
  • Praveen N. Chander,
  • Lukman Cheraghvandi,
  • Marian C. Clahsen-van Groningen,
  • Marian C. Clahsen-van Groningen,
  • Stanley de Almeida Araujo,
  • Dilek Ertoy Baydar,
  • Mark Formby,
  • Mark Formby,
  • Danica Galesic Ljubanovic,
  • Loren Herrera Hernandez,
  • Eva Honsova,
  • Nasreen Mohamed,
  • Yasemin Ozluk,
  • Marion Rabant,
  • Virginie Royal,
  • Heather L. Stevenson,
  • Maria Fernanda Toniolo,
  • Diana Taheri,
  • Diana Taheri

DOI
https://doi.org/10.3389/ti.2023.11590
Journal volume & issue
Vol. 36

Abstract

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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.

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