Abstract
In the Banff classification, arteritis and tubulitis are regarded as the principal histological lesions indicating acute renal allograft rejection. To test this claim, we examined 51 biopsies obtained from 21 children and young adults with transplant rejection. Two reviewers, blind to the clinical course, graded the biopsies according to the Banff scheme. In patients without significant tubulitis (borderline changes), rejection tended to be reversed easily (88%), often with methylprednisolone pulse (52%). In patients with arteritis or significant tubulitis (Banff I–III), rejection was reversed in only 23% (P < 0.001), in 9% with steroids, and in 14% with OKT3. Salvage of the graft was achieved in 26 of 35 (74%) with a score < 5 but in only 1 of 12 (8%) with a score ≥5 (P < 0.001). All 6 patients with vasculitis lost their grafts despite methylprednisolone pulse and OKT3. We conclude that the Banff classification predicts accurately the outcome of renal allograft rejection in children and may aid in choosing appropriate therapy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Sibley RK, Payne W (1985) Morphologic findings in the renal allograft biopsy. Semin Nephrol 5: 294–305
Olsen TS (1992) Pathology of allograft rejection. In: Burdick JF et al. (eds) Kidney transplant rejection: diagnosis and treatment, Dekker, New York, pp 333–357
Medawar PB (1944) The behaviour and fate of skin autografts and skin homografts in rabbits. J Anat 78: 176–199
Mitchison NA, Dube OL (1955) Studies on immunological response to foreign tumor transplants in the mouse. II. Relation between hemagglutinating antibody and graft resistance in normal mouse and mice pretreated with tissue preperations. J Exp Med 102: 179–199
Solez K, Marcussen N, Flynn GJ, Beshorner WE, Racusen LC, Burdick JF (1992) Pathology of acute tubular necrosis and acute rejection. In: Burdick JF et al. (eds) kidney transplant rejection: diagnosis and treatment. Dekker, New York, pp 373–392
Matas AJ, Sibley R, Mauer M, Sutherland DE, Simmons RL, Najarian JS (1983) The value of needle renal allograft biopsy. I. A retrospective study of biopsies performed during putative rejection episodes. Ann Surg 197: 226–237
Gray DWR, Richardson A, Hughes D, Fuggles S, Dunnill M, Higgins R, McWhinnie D, Morris PJ (1992) A prospective, randomized, blind comparison of three biopsy techniques in the management of patients after renal transplantation. Transplantation 53: 1226–1232
Burdick JF, Bechorner WE, Smith WJ, McGraw DJ, Bender WL, Williams GM, Solez K (1984) Characteristics of early routine renal allograft biopsies. Transplantation 38: 679–684
Versluis DJ, Kate FJ ten, Wenting GJ, Weimar W (1988) Mononuclear cells infiltrating allografts in the absence of rejection: effect of conversion from cyclosporin to azathioprine therapy. Transplant Int 1: 205–208
Guettier C, Nochy S, Hinglais N, Pelletier L, Mandet C, Bedrossian J, Duboust A, Moulonguet Doleris L, Camilleri JP, Bariety J (1988) Distinct phenotypic composition of diffuse interstitial and perivascular focal infiltrates in renal allografts: a morphometric analysis of cellular infiltration under conventional immunosuppressive therapy and under cyclosporine A. Clin Neprol 30: 97–105
Sibley RK, Rynasiewicz J, Ferguson RM, Fryd D, Sutherland DE, Simmons RL, Najarian JS (1983) Morphology of cyclosporine nephrotoxicity and acute rejection in patients immunosuppressed with cyclosporine and prednisone. Surgery 94: 225
D'ardenne AJ, Dunhill MS, Thompson JF, McWhinnie D, Wood RFM, Morris PJ (1986) Cyclosporine and renal graft histology. J Clin Pathol 39: 145–151
Solez K, Axelsen RA, Benediktsson H, Burdick JF, Cohen AH, Colvin RB, Croker BP, Droz D, Dunnill MS, Halloran PF, Hayry P, Jennette JC, Keown PA, Marcussen N, Mihatsch MJ, Morozumi K, Myers BD, Nast CC, Olsen S, Racusen LC, Ramos EL, Rosen S, Sachs DH, Solomon DR, Sanfilippo F, Verani R, Willebrand E von, Yamaguchi Y (1993) International standardization of criteria for the histologic diagnosis of renal allograft rejection: the Banff working classification of kidney transplant pathology. Kidney Int 44: 411–422
Porter KA, Thomson WB, Owen K, Kenyon JR, Mowbray JF, Peart WS (1963) Obliterative vascular changes in four human kidney homotransplants. BMJ 2: 639–645
Kincaid-Smith P (1967) Histological diagnosis of rejection in renal homografts in man. Lancet II: 849–852
Truong LD, Farhood A, Tasby J, Gillum D (1992) Experimental chronic renal ischemia: morphologic and immunologic studies. Kidney Int 41: 1676–1689
Anaise D, Oster ZH, Atkins HL, Arnold AN, Weis S, Waltzer WC, Rapaport FT (1986) Cortex perfusion index: a sensitive detector of acute rejection crisis in transplanted kidneys. J Nucl Med 27: 1697–1701
Preston DF, Luke GR (1979) Radionuclide evaluation of renal transplants. J Nucl Med 20: 1095–1097
Murphy AM, Robertson RJ, Dubbin PA (1987) Duplex ultrasound in the assessment of renal transplant conditions. Clin Radiol 38: 229–234
Rifkin MD, Needleman L, Pasto ME, Kurtz AB, Foy PM, McGlynn E, Canino C, Baltarowich OH, Pennell RG, Goldberg BB (1987) Evaluation of renal transplant rejection by duplex Doppler examination. Value of the resistive index. AJR 148: 759–762
Truong L, Mawad J, Hameed A, Farhood A (1991) Tubulitis in renal diseases (abstract). Lab Invest 64: 99A
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Corey, H.E., Greenstein, S.M., Tellis, V. et al. Renal allograft rejection in children and young adults: the Banff classification. Pediatr Nephrol 9, 309–312 (1995). https://doi.org/10.1007/BF02254194
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02254194