NYMC Faculty Publications

Thrombotic Microangiopathy in the Renal Allograft: Results of the TMA Banff Working Group Consensus on Pathologic Diagnostic Criteria

Marjan Afrouzian, Department of Pathology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States.
Nicolas Kozakowski, Department of Pathology, Medical University of Vienna, Vienna, Austria.
Helen Liapis, Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States.
Verena Broecker, Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Luon Truong, Department of Pathology, The Houston Methodist Hospital, Houston, TX, United States.
Carmen Avila-Casado, Laboratory Medicine Program, University Health Network (UHN), Toronto, ON, Canada.
Heinz Regele, Department of Pathology, Medical University of Vienna, Vienna, Austria.
Surya Seshan, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States.
Josephine M. Ambruzs, Arkana Laboratories, Little Rock, AR, United States.
Alton Brad Farris, Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States.
David Buob, Department of Pathology, Université de Sorbonne, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France.
Praveen N. Chander, New York Medical College, Valhalla, NY, United States.
Lukman Cheraghvandi, Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, United States.
Marian C. Clahsen-van Groningen, Department of Pathology and Clinical Bioinformatics, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands.
Stanley de Almeida Araujo, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Dilek Ertoy Baydar, Department of Pathology, School of Medicine, Koç University, Sarıyer, Türkiye.
Mark Formby, Department of Anatomical Pathology, NSW Health Pathology, Callaghan, NSW, Australia.
Danica Galesic Ljubanovic, Department of Pathology, School of Medicine, University of Zagreb, Zagreb, Croatia.
Loren Herrera Hernandez, Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, United States.
Eva Honsova, AeskuLab Pathology and Department of Pathology, Charles University, Prague, Czechia.
Nasreen Mohamed, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia.
Yasemin Ozluk, Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye.
Marion Rabant, Department of Pathology, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France.
Virginie Royal, Department of Pathology, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada.
Heather L. Stevenson, Department of Pathology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States.
Maria Fernanda Toniolo, Kidney Pancreas Transplantation, Instituto de Nefrología-Nephrology, Buenos Aires, Argentina.
Diana Taheri, Department of Pathology, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Author Type(s)

Faculty

Journal Title

Transplant International

First Page

11590

Document Type

Article

Publication Date

1-1-2023

Department

Pathology, Microbiology and Immunology

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.

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