Banff 2022 pancreas transplantation multidisciplinary report: Refinement of guidelines for T cell–mediated rejection, antibody-mediated rejection and islet pathology. Assessment of duodenal cuff biopsies and noninvasive diagnostic methods

• Published in: American journal of transplantation Vol. 24; no. 3; pp. 362 - 379
• Main Authors: Drachenberg, Cinthia B., Buettner-Herold, Maike, Aguiar, Pedro Ventura, Horsfield, Catherine, Mikhailov, Alexei V., Papadimitriou, John C., Seshan, Surya V., Perosa, Marcelo, Boggi, Ugo, Uva, Pablo, Rickels, Michael, Grzyb, Krzyztof, Arend, Lois, Cuatrecasas, Miriam, Toniolo, Maria Fernanda, Farris, Alton B., Renaudin, Karine, Zhang, Lizhi, Roufousse, Candice, Gruessner, Angelika, Gruessner, Rainer, Kandaswamy, Raja, White, Steven, Burke, George, Cantarovich, Diego, Parsons, Ronald F., Cooper, Matthew, Kudva, Yogish C., Kukla, Aleksandra, Haririan, Abdolreza, Parajuli, Sandesh, Merino-Torres, Juan Francisco, Argente-Pla, Maria, Meier, Raphael, Dunn, Ty, Ugarte, Richard, Rao, Joseph Sushil, Vistoli, Fabio, Stratta, Robert, Odorico, Jon
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2024
• Subjects: acute T cell–mediated rejection; antibody-mediated rejection; Biopsy; donor-specific antibody; Isoantibodies; mixed rejection; pancreas after kidney transplant; Pancreas Transplantation; percutaneous pancreas biopsy; simultaneous pancreas kidney transplant; solitary pancreas transplant; T-Lymphocytes; Transplantation, Homologous; whole pancreas transplantation; percutaneous pancreas biopsy; DM; PNF; solitary pancreas transplant; T1DR; antibody-mediated rejection; dd cf DNA; SPK; pancreas after kidney transplant; simultaneous pancreas kidney transplant; DSA; PTLD; HbA1c; donor-specific antibody; DGF; PTxBx; acute T cell–mediated rejection; AMR; AI; CIN; IAC; whole pancreas transplantation; CMV; Igls criteria; AR; C4d; TF; CD3; GEP; TCMR; mixed rejection; PAK; CD68; dnDSA; PTA
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1016/j.ajt.2023.10.011

The Banff pancreas working schema for diagnosis and grading of rejection is widely used for treatment guidance and risk stratification in centers that perform pancreas allograft biopsies. Since the last update, various studies have provided additional insight regarding the application of the schema and enhanced our understanding of additional clinicopathologic entities. This update aims to clarify terminology and lesion description for T cell–mediated and antibody-mediated allograft rejections, in both active and chronic forms. In addition, morphologic and immunohistochemical tools are described to help distinguish rejection from nonrejection pathologies. For the first time, a clinicopathologic approach to islet pathology in the early and late posttransplant periods is discussed. This update also includes a discussion and recommendations on the utilization of endoscopic duodenal donor cuff biopsies as surrogates for pancreas biopsies in various clinical settings. Finally, an analysis and recommendations on the use of donor-derived cell-free DNA for monitoring pancreas graft recipients are provided. This multidisciplinary effort assesses the current role of pancreas allograft biopsies and offers practical guidelines that can be helpful to pancreas transplant practitioners as well as experienced pathologists and pathologists in training.