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Table 2 Interpretation of the Banff Classification

From: Renal association clinical practice guideline in post-operative care in the kidney transplant recipient

Banff code Descriptive term Pathophysiology Interpretation Treatment
i Interstitial inflammation Infiltration of interstitium by mononuclear cells Linked with cellular rejection but also viral infection Intensification of immunosuppression –often pulsed intravenous steroids
t Tubulitis Infiltration of renal tubules by mononuclear cells Linked with cellular rejection but also viral infection Intensification of immunosuppression –often pulsed intravenous steroids
g Glomerulitis Margination of inflammatory leukocytes in the glomerular capillary loops Marker of humeral rejection Intensification of immunosuppression if not too much chronic damage
v Arterial inflammation Inflammation of arterial wall with infiltration of mononuclear cells Marker of either severe cellular rejection or humeral rejection Intensification of immunosuppression ifnot too much chronic damage
ptc Peritubular capillaritis Margination of inflammatory cells in the peritubular capillaries Marker of humeral rejection Intensification of immunosuppression if not too much chronic damage
ci Interstitial Fibrosis Interstitial structure replaced by fibrosis Marker of chronic damage Poor prognostic sign – may prompt reduction in CNI
ct Tubular atrophy Interstitial tubules involuted Marker of chronic damage Poor prognostic sign – may prompt reduction in CNI
cg Transplant glomerulopathy Interposition of mesangium and thickening of GBM Associated with proteinuria and development of DSAs – End lesion of CAMR Poor prognosis – no known treatment but intensification of immunosuppression often practiced
mm Mesangial matrix expansion Increase of thickness of mesangial matrix Marker of microvascular damage to glomerulus Usually interpreted in association with other findings
cv Arterial fibrointimal thickening Expansion of intima between endothelium and media Marker of chronic damage – non-specific Poor prognostic sign – vascular protective measures
ah Arteriolar hyalinosis Nodular deposition of hyaline CNI toxicity but non-specific (e.g. HT, DM, lipids) Reduction or withdrawal of CNI