ESPN 51th Annual Meeting

ESPN 2018


 
Improving diagnosis and management with updated Banff histopathological classification in paediatric renal transplant biopsies
EVGENIA PREKA 1 SERGIO CAMILO LOPEZ GARCIA 1 NICOS KESSARIS 1 JELENA STOJANOVIC 1 NIZAM MAMODE 1 NEIL SEBIRE 2 JON JIN KIM 1 THYVIA SEKAR 2 STEPHEN MARKS 1

1- DEPARTMENT OF PAEDIATRIC NEPHROLOGY, GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST, LONDON, UK
2- DEPARTMENT OF PAEDIATRIC PATHOLOGY, GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST, LONDON, UK
 
Introduction:

Since the publication of the 2013 Banff classification, adult studies have shown evidence of improved prognosis using the new histopathological criteria; although there is no previous study looking at the impact of the new classification on the diagnosis of acute antibody-mediated rejection (ABMR) in paediatric renal transplant recipients (pRTR).

Material and methods:

This single-centre retrospective study evaluates 56 pRTR with donor-specific antibodies (DSA) who had a renal transplant biopsy performed due to allograft dysfunction between January 2006 and March 2012. Their biopsies were re-scored by a solitary specialist trained in 2013 Banff classification. The results were compared with previous classification as per 2003/2007 Banff criteria.  

Results:

At the time of biopsy, our population presented a mean age of 10±4.8 years old, maximum DSA mean fluorescence intensity (MFI) 4809 (2220.5 - 8921.5), estimated glomerular filtration rate of 40.5 (32.7-52.5) mls/min/1.73m2. Following the 2013 Banff classification, there were 7 cases (12.5%) diagnosed with ABMR that would have been missed when applying the old 2003/2007 classification. Evaluating the histological features of all the ABMR-related cases we have outlined the importance of V- (intimal arteritis) and T- (tubulitis) lesions in the ABMR cases: the absence of v- and t-lesions in the biopsy is related to a significantly higher graft survival (OR 7.3, 95%CI 1.1 - 48.8, p = 0.03 and OR 5.3, 95%CI 1.2 - 25.5, p = 0.04 respectively). Moreover, the absence of t- lesions was associated with significantly less rejection episodes the year after the initial biopsy (OR 5.1, 95%CI 1.4 - 19.8, p = 0.01).

Conclusions:

Considering the clinical outcomes in our cohort we definitely support the Banff 2013 classification as a more precise classification for the childhood post-transplant prognosis especially in the diagnosis of ABMR.