Transplant International (Aug 2023)
Delphi: A Democratic and Cost-Effective Method of Consensus Generation in Transplantation
- Marjan Afrouzian,
- Nicolas Kozakowski,
- Helen Liapis,
- Verena Broecker,
- Luan 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
Affiliations
- Marjan Afrouzian
- Department of Pathology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
- Nicolas Kozakowski
- Department of Pathology, Medical University of Vienna, Vienna, Austria
- Helen Liapis
- Nephrology Center, Ludwig Maximilian University of Munich, Munich, Germany
- Verena Broecker
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Luan Truong
- Department of Pathology and Genomic Medicine, The Houston Methodist Hospital, Houston, TX, United States
- Carmen Avila-Casado
- Laboratory Medicine Program, Toronto General Hospital, University Health Network (UHN), Toronto, ON, Canada
- Heinz Regele
- Department of Pathology, Medical University of Vienna, Vienna, Austria
- Surya Seshan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States
- Josephine M. Ambruzs
- Arkana Laboratories, Little Rock, AR, United States
- Alton Brad Farris
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States
- David Buob
- 0Department of Pathology, Université de Sorbonne, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, Paris, France
- Praveen N. Chander
- 1New York Medical College, Valhalla, NY, United States
- Lukman Cheraghvandi
- 2Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, United States
- Marian C. Clahsen-van Groningen
- 3Department of Pathology and Clinical Bioinformatics, Erasmus University Center Rotterdam, Rotterdam, Netherlands
- Marian C. Clahsen-van Groningen
- 4Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, Aachen, Germany
- Stanley de Almeida Araujo
- 5Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Dilek Ertoy Baydar
- 6Department of Pathology, Koç University School of Medicine, Istanbul, Türkiye
- Mark Formby
- 7Department of Anatomical Pathology, NSW Health Pathology, Callaghan, NSW, Australia
- Mark Formby
- 8School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Danica Galesic Ljubanovic
- 9Department of Pathology, School of Medicine, University of Zagreb, Zagreb, Croatia
- Loren Herrera Hernandez
- 0Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
- Eva Honsova
- 1AeskuLab Pathology and Department of Pathology, Charles University, Prague, Czechia
- Nasreen Mohamed
- 2Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
- Yasemin Ozluk
- 3Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
- Marion Rabant
- 4Department of Pathology, Necker-Enfants Malades Hospital, Université de Paris Cité, Paris, France
- Virginie Royal
- 5Department of Pathology, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada
- Heather L. Stevenson
- Department of Pathology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
- Maria Fernanda Toniolo
- 6Kidney Pancreas Transplantation, Instituto de Nefrología-Nephrology, Buenos Aires, Argentina
- Diana Taheri
- 7Department of Pathology, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Diana Taheri
- 8Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- DOI
- https://doi.org/10.3389/ti.2023.11589
- Journal volume & issue
-
Vol. 36
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.
Keywords
