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©2013 UpToDate ® Print Email Banff diagnostic criteria for rejection and allograft nephropathy 1. Normal 2. Antibody-mediated rejection Rejection: due, at least in part, to documentedanti-donor antibody (suspicious for if antibody not demonstrated). Maycoincide with categories 3, 4 and 5 - see below Type (grade) 1. ATN-like - C4d+, minimal inflammation 2. Capillary - C4d+, capillary margination and/or thrombosis 3. Arterial - C4d+, transmural arteritis (v3) (see section 4, grade III below) 3. Borderline changes Suspicious for acute cellular rejection. Nointimal arteritis ispresent, but there are foci of mile tubulitis (1-4mononuclear cells/tubular cross-section). May coincide with categories2 and 5 4. Acute/active cellular rejection T-cell mediated rejection; may coincide with categories 2 and 5 Type (grade) of histopathological findings: 1A Cases with significant interstitial infiltration (>25% of parenchyma affected) and foci of moderate tubulitis (>4mononuclear cells/tubular cross section or group of 10 tubular cells) 1B Cases with significant interstitial infiltration (>25% of parenchyma affected) and foci of severe tubulitis (>10mononuclear cells/tubular cross-section or group of 10 tubular cells) 2A Cases with mild to moderate intimal arteritis (v1) 2B Cases with severe intimal arteritis comprising >25% of the luminal area (v2) 3 Cases with transmural arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation (v3) 5. Chronic/sclerosing allograft nephropathy Fibrosing changes in the allograft, with orwithout features of true alloimmune injury to the graft; may coincidewith categories 2, 3 and 4. Grade 1 Mild interstitial fibrosis and tubular atrophy without (a) or with (b) specific changes suggesting chronic (mild) rejection Grade 2 Moderate interstitial fibrosis and tubular atrophy (a) or (b) (moderate) Grade 3 Severe interstitial fibrosis and tubular atrophy and tubular loss (a) or (b) (severe) 6. Other Changes not considered to be due to rejection; may coincide with categories 2, 3, 4 and 5. Modified from: Racusen, CR, Solez, K, Mihatsch, MJ, et al. Am J Transplant 2003; 3:708.