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; Stanley de Almeida Araujo; Dilek Ertoy Baydar; 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

doi:10.3389/ti.2023.11590

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
, Stanley de Almeida Araujo
, Dilek Ertoy Baydar
, 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

^*Corresponding author for this work

Pathology

University of Texas Medical Branch at Galveston
Medical University of Vienna
Washington University School of Medicine in St. Louis
Ludwig Maximilian University of Munich
Sahlgrenska University Hospital
Houston Methodist
University Health Network
Cornell University
Arkana Laboratories
Emory University
Tenon Hospital
New York Medical College
Baylor College of Medicine
Universidade Federal de Minas Gerais
Koc University
NSW Health Pathology
University of Newcastle
Pediatric Clinic, University of Zagreb
Mayo Clinic Rochester, MN
Charles University
King Fahad Specialist Hospital, Dammam
Istanbul University
Université Paris Cité
University of Montreal
Instituto de Nefrología-Nephrology
Isfahan University of Medical Sciences
RWTH Aachen University

Research output: Contribution to journal › Article › Academic › peer-review

17 Citations (Scopus)

31 Downloads (Pure)

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.

Original language	English
Article number	11590
Journal	Transplant International
Volume	36
DOIs	https://doi.org/10.3389/ti.2023.11590
Publication status	Published - 23 Aug 2023

Bibliographical note

Funding Information:
This study was performed under the auspices of the Banff Foundation on Allograft Pathology and supported by grants from the Banff Foundation (for publication fees) and Alexion Pharmaceuticals (#100288). 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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10.3389/ti.2023.11590Licence: CC BY

Thrombotic Microangiopathy in the Renal AllograftFinal published version, 1.41 MBLicence: CC BY

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Afrouzian, M., Kozakowski, N., Liapis, H., Broecker, V., Truong, L., Avila-Casado, C., Regele, H., Seshan, S., Ambruzs, J. M., Farris, A. B., Buob, D., Chander, P. N., Cheraghvandi, L., Clahsen-van Groningen, M. C., de Almeida Araujo, S., Ertoy Baydar, D., Formby, M., Galesic Ljubanovic, D., Herrera Hernandez, L., ... Taheri, D. (2023). Thrombotic Microangiopathy in the Renal Allograft: Results of the TMA Banff Working Group Consensus on Pathologic Diagnostic Criteria. Transplant International, 36, Article 11590. https://doi.org/10.3389/ti.2023.11590

@article{4cdc64fc536243c5a5e59bf27db3f0db,

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

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.",

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

note = "Funding Information: This study was performed under the auspices of the Banff Foundation on Allograft Pathology and supported by grants from the Banff Foundation (for publication fees) and Alexion Pharmaceuticals (\#100288). 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 {\textcopyright} 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.",

year = "2023",

month = aug,

day = "23",

doi = "10.3389/ti.2023.11590",

language = "English",

volume = "36",

journal = "Transplant International",

issn = "0934-0874",

publisher = "Frontiers Media SA",

}

Afrouzian, M, Kozakowski, N, Liapis, H, Broecker, V, Truong, L, Avila-Casado, C, Regele, H, Seshan, S, Ambruzs, JM, Farris, AB, Buob, D, Chander, PN, Cheraghvandi, L, Clahsen-van Groningen, MC, de Almeida Araujo, S, Ertoy Baydar, D, Formby, M, Galesic Ljubanovic, D, Herrera Hernandez, L, Honsova, E, Mohamed, N, Ozluk, Y, Rabant, M, Royal, V, Stevenson, HL, Toniolo, MF & Taheri, D 2023, 'Thrombotic Microangiopathy in the Renal Allograft: Results of the TMA Banff Working Group Consensus on Pathologic Diagnostic Criteria', Transplant International, vol. 36, 11590. https://doi.org/10.3389/ti.2023.11590

TY - JOUR

T1 - Thrombotic Microangiopathy in the Renal Allograft

T2 - Results of the TMA Banff Working Group Consensus on Pathologic Diagnostic Criteria

AU - Afrouzian, Marjan

AU - Kozakowski, Nicolas

AU - Liapis, Helen

AU - Broecker, Verena

AU - Truong, Luon

AU - Avila-Casado, Carmen

AU - Regele, Heinz

AU - Seshan, Surya

AU - Ambruzs, Josephine M.

AU - Farris, Alton Brad

AU - Buob, David

AU - Chander, Praveen N.

AU - Cheraghvandi, Lukman

AU - Clahsen-van Groningen, Marian C.

AU - de Almeida Araujo, Stanley

AU - Ertoy Baydar, Dilek

AU - Formby, Mark

AU - Galesic Ljubanovic, Danica

AU - Herrera Hernandez, Loren

AU - Honsova, Eva

AU - Mohamed, Nasreen

AU - Ozluk, Yasemin

AU - Rabant, Marion

AU - Royal, Virginie

AU - Stevenson, Heather L.

AU - Toniolo, Maria Fernanda

AU - Taheri, Diana

N1 - Funding Information: This study was performed under the auspices of the Banff Foundation on Allograft Pathology and supported by grants from the Banff Foundation (for publication fees) and Alexion Pharmaceuticals (#100288). 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.

PY - 2023/8/23

Y1 - 2023/8/23

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85169883444

U2 - 10.3389/ti.2023.11590

DO - 10.3389/ti.2023.11590

M3 - Article

C2 - 37680648

AN - SCOPUS:85169883444

SN - 0934-0874

VL - 36

JO - Transplant International

JF - Transplant International

M1 - 11590

ER -

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

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