학술논문
Thrombotic Microangiopathy in the Renal Allograft: Results of the TMA Banff Working Group Consensus on Pathologic Diagnostic Criteria.
Document Type
Article
Author
Afrouzian, Marjan; Kozakowski, Nicolas; Liapis, Helen; Broecker, Verena; Luon Truong; Avila-Casado, Carmen; Regele, Heinz; Seshan, Surya; Ambruzs, Josephine M.; Farris, Alton Brad; Buob, David; Chander, Praveen N.; Cheraghvandi, Lukman; Clahsen-van Groningen, Marian C.; de Almeida Araujo, Stanley; Baydar, Dilek Ertoy; Formby, Mark; Galesic Ljubanovic, Danica; Herrera Hernandez, Loren; Honsova, Eva
Source
Subject
*DELPHI method
*HOMOGRAFTS
*KIDNEY transplantation
*PATHOLOGICAL laboratories
*DIFFERENTIAL diagnosis
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Language
ISSN
0934-0874
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. [ABSTRACT FROM AUTHOR]