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, Stanley de Almeida Araujo, Dilek Ertoy Baydar, Mark Formby, Danica Galesic Ljubanovic, Loren Herrera Hernandez, Eva HonsovaNasreen Mohamed, Yasemin Ozluk, Marion Rabant, Virginie Royal, Heather L. Stevenson, Maria Fernanda Toniolo, Diana Taheri

*Corresponding author for this work

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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.

Original languageEnglish
Article number11589
JournalTransplant International
Publication statusPublished - 23 Aug 2023

Bibliographical note

Funding Information:
The authors declare that this study received funding from Alexion Pharmaceuticals (grant # 100288) and the Banff Foundation on Allograft Pathology (for publication fees). The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.

Publisher Copyright:
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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