NYMC Faculty Publications

Delphi: A Democratic and Cost-Effective Method of Consensus Generation in Transplantation


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 Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Luan Truong, Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, United States.
Carmen Avila-Casado, Krembil Brain Institute, 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 Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Dilek Ertoy Baydar, Department of Neurology, School of Medicine, Koç University, Istanbul, 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 Laboratory Medicine and Pathology, 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 de 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.

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Transplant International

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Pathology, Microbiology and Immunology


The Thrombotic Microangiopathy Banff Working Group (TMA-BWG) was formed in 2015 to survey current practices and develop minimum diagnostic criteria (MDC) for renal transplant TMA (Tx-TMA). To generate consensus among pathologists and nephrologists, the TMA BWG designed a 3-Phase study. Phase I of the study is presented here. Using the Delphi methodology, 23 panelists with >3 years of diagnostic experience with Tx-TMA pathology listed their MDC suggesting light, immunofluorescence, and electron microscopy lesions, clinical and laboratory information, and differential diagnoses. Nine rounds (R) of consensus resulted in MDC validated during two Rs using online evaluation of whole slide digital images of 37 biopsies (28 TMA, 9 non-TMA). Starting with 338 criteria the process resulted in 24 criteria and 8 differential diagnoses including 18 pathologic, 2 clinical, and 4 laboratory criteria. Results show that 3/4 of the panelists agreed on the diagnosis of 3/4 of cases. The process also allowed definition refinement for 4 light and 4 electron microscopy lesions. For the first time in Banff classification, the Delphi methodology was used to generate consensus. The study shows that Delphi is a democratic and cost-effective method allowing rapid consensus generation among numerous physicians dealing with large number of criteria in transplantation.