Banff and Beyond presentation for Tx Update meeting in Ahmedabad, India, September 29, 2012.

1. Kim Solez

2. 
Images from 1991

3. .
The Banff Schema
was first developed
by a group of pathologists,
nephrologists, and transplant surgeons at a
meeting in Banff Canada August 2-4, 1991..
It has continued to evolve through meetings every
two years and has become the worldwide standard for
interpretation of transplant biopsies.

4.  A moderated self-organizing group to define and
standardize organ allograft biopsy interpretation
 Aim is to promote international uniformity in
reporting allograft pathology, which is necessary for
research, clinical trials, and standardized patient
management
 International and inter-disciplinary process with
meetings every 2 years
 Mini-review “The Banff Classification Revisited”
(Solez, K. and Racusen, L.C.) will be appearing in
Kidney International later this year.
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5.  In 1990 all standard textbooks were inaccurate in
interpretation of kidney transplant biopsies
◦ Suggesting, for example, that arteritis meant that the
kidney was doomed and antirejection treatment should
be abandoned
 It became imperative for the field to correct this
and standardize interpretation
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6. • Began in kidney (Solez
et al. 1993), and was
then extended to liver,
pancreas, composite
tissue grafts etc.
Meetings also consider
heart, lung, small bowel.
• Uses semi-quantitative
lesion scoring 0-3+ and
diagnostic categories.

7.  Normal
 Antibody-mediated rejection,
 Borderline changes: ‘Suspicious’ for acute cellular
rejection
 T-cell-mediated rejection (may coincide with
categories 2 and 5 and 6)
 Sclerosis, interstitial fibrosis, and tubular atrophy,
no evidence of any specific etiology
 Other changes not considered to be due to
rejection

8.  Transplant glomerulitis - g
 Chronic transplant glomerulopathy - cg
 Interstitial Inflammation - i (ti)
 Interstitial fibrosis - ci
 Tubulitis - t
 Tubular atrophy - ct
 Vasculitis, intimal arteritis - v
 Fibrous intimal thickening - cv
 Arteriolar hyaline thickening - ah (aah)
 Mesangial matrix increase - mm
 Peritubular capillary cell accumulation - ptc Singularity
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9.  Genome Canada
transplant transcriptome project.
Affymetrix GeneChip® probe array.
Image courtesy of Affymetrix.
 Traditional pathology techniques.

11.  1991 First Conference
 1993 First Kidney International publication
 1995 Integration with CADI
 1997 Integration with CCTT classification
 1999 Second KI paper. Clinical practice guidelines. Implantation biopsies,
microwave.
 2001 Classification of antibody-mediated rejection
◦ Regulatory agencies participating
 2003 Genomics focus, ptc cell accumulation scoring
 2005 Gene chip analysis. Elimination of CAN, identification of chronic
antibody-mediated rejection.
 2007 First meeting far from a town called “Banff” – La Coruna, Spain.
 2009 Working groups. Meeting in Banff, Alberta, Canada for last time until
2015!
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12. 86% Kidney clinical
6% Liver clinical Most articles are in high quality journals
5% Kidney experimental with impact factor of 3.2 or higher,
1% Liver experimental one third have impact factors of 6-9.

13.  The Banff meeting reports and main meeting
papers have been cited 4,312 times in the
medical literature.
 The 1999 paper The Banff 97 Working
Classification of Renal Allograft Pathology
Kidney International 55(2):713-23, 1999 by
Racusen, Solez, and Colvin et al. is a citation
classic in the field having been cited 1,764
times.
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14.  Classification begun at 1991 Banff meeting has
become the worldwide standard, and the
consensus process has now extended to all solid
organs. Future meetings are planned every two
years through 2019.
 Standardization principles now being extended
from biopsy reporting to tissue typing, imaging, all
the other elements in transplant care.
 Classification used in clinical trials, and by the
FDA, mandatory evaluation for drug approvals.
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15. Banff Working Groups:
Addressing unmet needs in a data-driven, evidence based approach
Sis et al. 2009 Banff Meeting Report, Am J Transplant. 2010 Mar;10(3):464-71
Isolated v-lesion
Working Group
Fibrosis Scoring IHC Quality Assurance
Working Group Working Group
Data-driven & Validated
Refinement of the
Banff Guidelines
Glomerular Lesion Polyoma Virus Nephropathy
Working Group Working Group
C4d-Negative ABMR
Working Group

16.  Isolated V lesion – Banu Sis and Ed Kraus
 Fibrosis scoring – Robert Colvin
 Polyoma virus staging – Volker Nickeleit
 Glomerular lesion scoring – Mark Haas
 Molecular pathology – Phil Halloran
 Quality assurance IHC – Michael Mengel
 C4d neg. Ab-Mediated Rejection – Banu Sis
 History&Impact of Banff Process – Kim Solez
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17.  1.Defining appropriate thresholds for
microvascular injury and for DSA that provide
an optimal balance of specificity and sensitivity
for ABMR, noting that none of these
morphologic changes are specific and that not
all patients with DSA have ABMR.
 2. Defining "C4d-negative". There is some
evidence that focal C4d is often (though less so
than diffuse C4d) associated with DSA and
microvascular injury.
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18.  3.
Defining acute versus chronic/active Ab-
mediated rejection.
 4.Defining the significance of intimal arteritis
(in the absence of necrosis) as histologic
evidence for Ab-mediated rejection.
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19. Includes analysis of physician facilitation of consensus discussions, seen most recently in
Bob Colvin’s C4d discussions and in Michael Mengel’s organization of Banff Working Groups.
Also includes analysis of future trends and developments.

20.  Future concepts of where
technology is taking us are
incorporated into long term
planning of Banff Process.
 Will be part of 2013 meeting in
Brazil.

21. • Until now we have
had none beyond Drs.
Racusen and Solez.
• Will form Swiss
foundation legal entity
in 2012, to enable us
to enter into formal
relationships with
other organizations
we cannot do now.

23.  To lead development and dissemination of the
international Banff Classification of Allograft
Pathology and to facilitate multidisciplinary,
collaborative research to enhance its scientific
basis and clinical utility to improve the care of
transplant patients.
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24.  Facilitation of knowledge generation and translation in
transplantation pathology with the ultimate aim to
improve patient outcome
 Maintaining the Banff spirit of a multinational,
multidisciplinary consensus group
 Fundraising
 Guidance and financial support for Working Group
activities
 Guidance and financial support for Banff meetings
activities
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25.  Responsible for annual reports of the Foundation and adherence to
Swiss law
 Fiduciary responsibility for foundation funds
 Final responsibility for selection and content of Banff meetings
 Support and guide Working Group activities
 External representation of the Banff process: fundraising, policy
papers, set up, content, and maintenance of a Banff website
 Bidirectional communication to membership of the Banff community
 Composition:
◦ The BOD consists of 6-9 members, including the Chair.
◦ Members are selected by majority vote of the BOD and serve for a 3 year
term, renewable once. Terms are staggered (3 selected each year).
◦ The Chair and Secretary/Treasurer are selected by a majority vote of the
BOD and serve for a 3 year term, renewable once.
◦ Vacancies filled by majority vote of BOD.
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26. Secretary/Treasurer
◦ Responsible for day-to-day business/activities of the Banff Foundation
and annual reporting
◦ Is a member of the board and regularly reports to the other board
members
◦ Prepares annual budget and projections
◦ Monitors expenses
◦ Works closely with the administrative team
Flow and handling of funds through the
 A foundation should generate funding from whatever sources over its
lifetime, to fulfil its purpose; which in this case would be to run Banff
meetings and to foster advances organ transplantation
 Therefore the recommendation is to run any money e.g. from a
pharmaceutical company into the Swiss Foundation, which then will at
the Board of Trustees instruction transferred to a trusted organising
committee, e.g. a University or Society account from local Banff meeting
organizers , or Banff working group leaders for supporting their activities

27.  Organization of meetings together with local organizers
 Organization of cross-organ plenary sessions
 Program finalization according to input from Organ
Steering committees
 Selection of speakers and moderators
 Support and coordination of preparation of meeting
reports
 Terms of references:
◦ Appointed by the BOD
◦ terms of membership four years (i.e. two meetings), renewable
through majority vote of the board
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28.  Should engage pathologists and clinicians as well as
representative from major geographic regions (e.g.
North America, South America, Europe, Asia, Africa,
Australia)
 Fund raising for the meetings and consensus work
should also be scope for the organ steering committee
members
 Organization of organ specific sessions: selection of
topics and speakers
 Preparation of organ specific meeting reports
 Terms of reference:
◦ Leadership appointed by the board of directors for four years (i.e.
two meetings), renewable through majority vote of the board
◦ Otherwise self-organized
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