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
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
- Luon 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 Pathology and Laboratory Medicine, 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 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.2023.11590
- Journal volume & issue
-
Vol. 36
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.
Keywords
