부산대학교 도서관

The aim of this study was to determine how the Banff antibody‐mediated rejection (ABMR) classification for kidney transplantation is interpreted in practice and affects therapy. The Banff Antibody‐Mediated Injury Workgroup electronically surveyed clinicians and pathologists worldwide regarding diagnosis and treatment for 6 case‐based scenarios. The participants' (95 clinicians and 72 renal pathologists) assigned diagnoses were compared to the Banff intended diagnoses (reference standard). The assigned diagnoses and reference standard differed by 26.1% (SD28.1%) for pathologists and 34.5% (SD23.3%) for clinicians. The greatest discordance between the reference standard and clinicians' diagnosis was when histologic features of ABMRwere present but donor‐specific antibody was undetected (49.4% [43/87]). For pathologists, the greatest discordance was in the case of acute/active ABMRC4d staining negative in a positive crossmatch transplant recipient (33.8% [23/68]). Treatment approaches were heterogeneous but linked to the assigned diagnosis. When acute/active ABMRwas diagnosed by the clinician, treatment was recommended 95.3% (SD18.4%) of the time vs only 77.7% (SD39.2%) of the time when chronic active ABMRwas diagnosed (P< .0001). In conclusion, the Banff ABMRclassification is vulnerable to misinterpretation, which potentially has patient management implications. Continued efforts are needed to improve the understanding and standardized application of ABMRclassification in the transplant community. A survey of an international group of transplant nephrologists and pathologists reveals that the Banff antibody‐mediated rejection classification is vulnerable to misinterpretation, which may have patient management implications. See page 9for Mannon's comments.