https://orcid.org/0000-0003-0565-9560
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Myrthe van Baardwijk, Anne Wagenmakers, Thierry P P van den Bosch, Dennis A Hesselink, Alexandre Loupy, Rafael Kramann, Jean-Paul Duong van Huyen, Marion Rabant, Marian C Clahsen-van Groningen, Borderline (suspicious) for T-cell-mediated rejection, the Banff classification's Achilles’ heel, Nephrology Dialysis Transplantation, Volume 40, Issue 2, February 2025, Pages 224–226, https://doi.org/10.1093/ndt/gfae192
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Kidney transplantation (KTx) is the main therapy for patients suffering from end-stage kidney disease. Unfortunately, the occurrence of acute rejection, mainly within the first year after transplantation, remains a major problem and is a significant risk factor for the development of future transplant failure. The current gold standard for diagnosing acute rejection is by histomorphological evaluation of a KTx biopsy using the Banff classification of renal allograft pathology, an international consensus-based classification updated every 2 years.
Challenges with borderline T-cell-mediated rejection: A difficult diagnosis within this classification is category 3—borderline (suspicious) for acute T-cell-mediated rejection (bTCMR). This diagnosis is based on minimal interstitial inflammation and the presence of tubulitis. Over the different updates of the Banff classification, there have been changes in the amount of interstitial inflammation needed to diagnose bTCMR, varying from <10% (i0) to 10%–25% (i1). During the discussions at the 2019 Banff meeting and research publications, the threshold for the amount of interstitial inflammation in bTCMR was increased to 10%–25% of the non-scarred cortical tissue [1]. These changes have had significant clinical implications, as they may have significantly affected the treatment and management strategies for patients.
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