Banff 2022 Liver Group Meeting report: Monitoring long-term allograft health

• Published in: American journal of transplantation Vol. 24; no. 6; pp. 905 - 917
• Main Authors: Bellamy, Christopher O.C., O'Leary, Jacqueline G., Adeyi, Oyedele, Baddour, Nahed, Batal, Ibrahim, Bucuvalas, John, Del Bello, Arnaud, El Hag, Mohamed, El-Monayeri, Magda, Farris, Alton B., Feng, Sandy, Fiel, Maria Isabel, Fischer, Sandra E., Fung, John, Grzyb, Krzysztof, Guimei, Maha, Haga, Hironori, Hart, John, Jackson, Annette M., Jaeckel, Elmar, Khurram, Nigar A., Knechtle, Stuart J., Lesniak, Drew, Levitsky, Josh, McCaughan, Geoff, McKenzie, Catriona, Mescoli, Claudia, Miquel, Rosa, Minervini, Marta I., Nasser, Imad Ahmad, Neil, Desley, O'Neil, Maura F., Pappo, Orit, Randhawa, Parmjeet, Ruiz, Phillip, Fueyo, Alberto Sanchez, Schady, Deborah, Schiano, Thomas, Sebagh, Mylene, Smith, Maxwell, Stevenson, Heather L., Taner, Timucin, Taubert, Richard, Thung, Swan, Trunecka, Pavel, Wang, Hanlin L., Wood-Trageser, Michelle, Yilmaz, Funda, Zen, Yoh, Zeevi, Adriana, Demetris, Anthony J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2024
• Subjects: alloimmunity; anatomy; antibody-mediated rejection; Banff classification; immunosuppression; liver transplantation; pathology; protocol biopsy; T cell-mediated rejection; alloimmunity; pathology; anatomy; AMR; immunosuppression; Banff classification; CP; antibody-mediated rejection; MFI; DSA; TCMR; T cell-mediated rejection; protocol biopsy; liver transplantation; IH
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1016/j.ajt.2024.03.008

The Banff Working Group on Liver Allograft Pathology met in September 2022. Participants included hepatologists, surgeons, pathologists, immunologists, and histocompatibility specialists. Presentations and discussions focused on the evaluation of long-term allograft health, including noninvasive and tissue monitoring, immunosuppression optimization, and long-term structural changes. Potential revision of the rejection classification scheme to better accommodate and communicate late T cell-mediated rejection patterns and related structural changes, such as nodular regenerative hyperplasia, were discussed. Improved stratification of long-term maintenance immunosuppression to match the heterogeneity of patient settings will be central to improving long-term patient survival. Such personalized therapeutics are in turn contingent on a better understanding and monitoring of allograft status within a rational decision-making approach, likely to be facilitated in implementation with emerging decision-support tools. Proposed revisions to rejection classification emerging from the meeting include the incorporation of interface hepatitis and fibrosis staging. These will be opened to online testing, modified accordingly, and subject to consensus discussion leading up to the next Banff conference.