The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials

Mark Haas, Alexandre Loupy, Carmen Lefaucheur, Candice Roufosse, Denis Glotz, Daniel Serón, Brian J. Nankivell, Philip F. Halloran, Robert B. Colvin, Enver Akalin, Nada Alachkar, Serena M. Bagnasco, Yassine Bouatou, Jan U. Becker, Lynn D. Cornell, J.P. Duong Van Huyen, Ian W. Gibson, Edward S. Kraus, Roslyn B. Mannon, Maarten Naesens, Volker Nickeleit, Peter Nickerson, Dorry L. Segev, Harsharan K. Singh, Mark D. Stegall, Parmjeet Randhawa, Lorraine C. Racusen, Kim Solez, Michael Mengel · American Journal of Transplantation · 2018 · medicine · 10.1111/ajt.14625 · record haas2018-the-banff-2017-kidney-meeting-repo
tag layer · index · concepts · authors · עברית
Where this record's text came from. 2026-08-23 schema-0.3 pass: every quote verified as an exact substring of the staged text and anchored at merge time; concept terms verified present; every edge endpoint an existing node.
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Tags on this paper

Every tag the record carries, each linking to every other paper in the corpus that carries it. A tag appears here whether or not its words occur in the article — the spans below are only the ones a sentence in this paper licenses. Of the 7 concept tags on this paper, all 7 are grounded in a quoted sentence. All carry the tagger's gloss of what the term means in this paper, which is not something the article can license.
chronic active TCMR acute TCMR borderline i‐IFTA tubulitis titration mean fluorescence intensity severely atrophic tubules i-IFTA score kappa expert-consensus
Method, as described: consensus meeting with working groups, each reporting a remit and a survey of current practice; revisions adopted into a published working classification

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relation to other workclaim_relationshow this paper stands to another: agrees, contradicts, extends, qualifies
claim typeclaim_typethe shape of the claim: existence, mechanism, method, critique, prediction, null
concept edgeconcept_edgesan asserted relation between two concepts, with the sentence asserting it
conceptconceptsan idea the paper works with, quoted where the paper uses it
content tagcontent_tagsa finding, definition, quantity, statistic or variable named in the paper
contributioncontributionwhat the paper claims to add
controlcontrolsan experiment run to eliminate a rival explanation
limitationlimitationswhat the paper says its evidence cannot support
mechanismmechanismshow the reported effect is said to come about
methodmethodhow the paper produced its evidence
object of studyobject_of_studywhat the paper is about — the thing it investigates
phenomenonphenomenonthe effect or regularity under study
research questionresearch_questionthe question the paper sets itself
sensesensesa distinct use of a term, quoted where the paper fixes it

The paper

The full text is not reproduced here. This article is not cleared for redistribution, so the page carries the tag layer only. Its evidence sentences are withheld; the grounding status remains with each tag, and the article itself is at https://doi.org/10.1111/ajt.14625. The reading view exists for the papers whose licence permits it.

Every tag on this page

claim_relations 2 · claim_type 1 · concept_edges 3 · concepts 7 · content_tags 13 · contribution 1 · controls 3 · limitations 4 · mechanisms 7 · method 1 · object_of_study 1 · phenomenon 1 · research_question 1 · senses 4

Relations on this page carry a quotation for the claim. Where a relation was separately evidenced — and so tested against the vocabulary for its type — the row says so; 3 of 3 relations here carry that mark. The rest are the tagger’s reading of the sentence quoted beside them.

facettagfieldconf.whose words
object_of_studyA DIAGNOSTIC CLASSIFICATION REVISING ITSELF IN PUBLIC - the fourteenth biennial Banff conference, which changed the criteria for two categories of kidney transplant rejection, named each revision by its meeting year, and published a survey of how its own users apply the previous version
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
object_of_studythe paper's words
research_questionwhether inflammation in areas of fibrosis and atrophy (i-IFTA) should be admitted to the classification as diagnostic of chronic active TCMR, and at what thresholds
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
research_questionthe paper's words
contributionthe 2017 revisions: tubulointerstitial criteria for chronic active TCMR added at i-IFTA 2-3 with tubulitis t2-3, ABMR criteria widened to admit C4d and validated molecular assays as alternatives to donor-specific antibodies, and the word 'acute' deleted from the ABMR category names
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contributionthe paper's words
claim_typemethod
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
claim_typethe paper's words
phenomenona controlled vocabulary whose own authors apply it non-uniformly, revised by consensus every two years against evidence that arrives between meetings
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
phenomenonthe paper's words
methodexpert-consensus
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
methodthe paper's words
mechanismsTHE VOCABULARY'S OWN AUTHORS DO NOT APPLY IT UNIFORMLY, AND THE PAPER SAYS SO IN ITS OWN WORKING-GROUP REPORT: `Survey among renal pathologists (including very experienced) revealed nonuniform application of current Banff TCMR cutoffs, consideration of non-Banff lesions in TCMR diagnosis, grading or nongrading of i-IFTA.` This corpus has records of vocabularies that failed on measurement (laubach2018) and of definitions that disagreed across papers; this is a body measuring the DISPERSION OF ITS OWN USERS and printing the result
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[0]0.95the tagger's words
mechanismsAND A WORD WAS REMOVED FROM THE CLASSIFICATION FOR A COMMUNICATIVE REASON, NOT A SCIENTIFIC ONE: `The term `ACUTE` (in acute/active ABMR) is confusing to clinicians, and consequently it has been removed from the Banff classification`. Nothing about the disease changed. The term was deleted because readers misread it - the same shape as macdonald2015 (WHO SAGE taking the narrower name for the broader concept for institutional reasons) and the ICTV's published change types, and the plainest case in the corpus of a definition edited for its AUDIENCE
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[1]0.95the tagger's words
mechanismsAND THE SURVEY SAYS HOW THE VOCABULARY IS MISREAD, NOT ONLY THAT IT IS: `Clinicians often fail to recognize chronic elements of ABMR (eg, cg >0)` and are `more likely to consider a diagnosis of chronic, active ABMR if C4d is negative, even if there is no TG, PTCBML, or IFTA`. A named direction of error against a named criterion
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[2]0.95the tagger's words
mechanismsAND A FEATURE EXCLUDED IN 1991 WAS ADMITTED IN 2017 BECAUSE THE POPULATION CHANGED, NOT THE FEATURE: `The nonspecificity of i-IFTA for rejection, proved by the fact that it occurs in native kidneys, was the main reason why i-IFTA and tubulitis in atrophic tubules was specifically excluded from the classification at the first Banff meeting. However, since 1991, immunosuppression has changed and graft survival improved with more patients presenting late posttransplantation with i-IFTA.` The lesion is exactly as nonspecific as it was; what moved is who gets biopsied
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[3]0.95the tagger's words
mechanismsAND A CATEGORY WAS DELIBERATELY NOT CREATED, BECAUSE ITS ANALOGUE PROVED UNDEFINABLE: `there is no borderline or suspicious category for chronic active TCMR, particularly as this category within acute TCMR has proved to be troublesome for treating clinicians and even for pathologists to define`. An absence with a stated reason - a committee declining to mint a term because the existing one of that shape does not work
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[4]0.95the tagger's words
mechanismsAND A LABELLING RULE EXISTS TO STOP THE SAME BIOPSY BEING COUNTED TWICE: `a biopsy fulfilling the diagnostic criteria for chronic active TCMR should not be given A SECOND DIAGNOSIS of Borderline or acute TCMR, because the latter already addresses the acute/ACTIVE COMPONENT` - while `biopsies with chronic active TCMR can have an additional diagnosis of ABMR`. Which co-diagnoses are permitted is part of the definition, and it is stated separately from the criteria
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[5]0.95the tagger's words
mechanismsAND THE MARKER PROPOSED AS A TRIAL ENDPOINT HAS THE SAME PROBLEM ONE LAYER DOWN: `current shortcomings of DSA testing (variability in test methods, diagnostic threshold definitions, clinical significance standards) are known to limit its utility as a sole endpoint`, with `Quotation withheld`. The definitional instability the meeting exists to fix in histology is present, unfixed, in the biomarker offered to replace it
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[6]0.95the tagger's words
limitationsTHE LESION ADMITTED TO THE CLASSIFICATION IS NOT SPECIFIC AND THE PAPER SAYS SO BEFORE ADMITTING IT: `Clearly, i-IFTA is not a specific lesion, and adding i-IFTA by itself, even if moderate to severe, to the classification as diagnostic of chronic active TCMR does not appear warranted based on present data. It is well known that many other disease processes, including BK virus infection, pyelonephritis, ABMR, recurrent glomerulonephritis, and obstruction, may at some point present with i-IFTA.` The criterion is therefore a CONJUNCTION with tubulitis plus an exclusion list, not the lesion alone
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
limitations[0]0.95the tagger's words
limitationsAND THE THRESHOLDS ARE SET WHERE THE OUTCOME ASSOCIATION STARTS, IN ONE COHORT: `i-IFTA scores of 2 and 3, but not 1, as well as t2 and t3 tubulitis (but not t1) within areas of IFTA, excluding severely atrophic tubules, were associated with an increased rate of graft loss.` The class boundary is drawn at the point where a prognostic signal appears - the same move as the ARF/AKI classifications in this corpus, and it inherits that cohort's population
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
limitations[1]0.95the tagger's words
limitationsand the committee names its own strategy rather than presenting the choice as forced: `This conservative approach has served the Banff group well in the past, with the introduction of C4d-negative ABMR. As with the latter, future modifications will be considered as new data emerge`. The classification is explicitly provisional, with the revision mechanism part of the publication
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
limitations[2]0.85the tagger's words
limitationsand the agreement figure behind the new criterion is three pathologists in one centre: `the Paris group reported GOOD AGREEMENT AMONG 3 PATHOLOGISTS in grading i-IFTA according to the Banff 2015 criteria, with complete agreement between all 3 PATHOLOGISTS IN 101 (67%) OF 150 CASES, and a KAPPA VALUE OF .62` - which is reported as good, and sits below this project's own controlled-vocabulary kappa of 0.702
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
limitations[3]0.95the tagger's words
controlsthe occurrence of i-IFTA in NATIVE (non-transplanted) kidneys - a population in which rejection is impossible
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
eliminates: the reading of i-IFTA as a rejection-specific lesion; it is the negative control that kept the lesion out of the classification for 26 years · outcome: held
controls[0]0.95the tagger's words
controlsrequiring tubulitis (t2-3) ALONGSIDE i-IFTA (2-3), inflammation in >25% of total cortex, and explicit exclusion of chronic pyelonephritis and BK nephropathy
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
eliminates: overdiagnosis of chronic active TCMR from a lesion the paper calls nonspecific in the same section · outcome: held
controls[1]0.95the tagger's words
controlsgrading of i-IFTA by 3 pathologists against the Banff 2015 criteria
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
eliminates: the objection that i-IFTA cannot be scored reproducibly, 'as scattered inflammatory cells are often seen in what might be considered by many pathologists to be bland fibrosis' · outcome: partial
controls[2]0.95the tagger's words
conceptschronic active TCMR
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concepts[0]0.95the paper's words
conceptsacute TCMR
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: acute TCMR
concepts[1]0.95the paper's words
conceptsborderline
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: borderline
concepts[2]0.95the paper's words
conceptsi‐IFTA
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: i‐IFTA
concepts[3]0.95the paper's words
conceptstubulitis
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: tubulitis
concepts[4]0.95the paper's words
conceptstitration
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: titration
concepts[5]0.95the paper's words
conceptsmean fluorescence intensity
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concepts[6]0.95the paper's words
senses`chronic active TCMR` (Banff 2017) - EXTENDED to the tubulointerstitial compartment: i-IFTA score 2-3 WITH tubulitis t2-3 in all but severely atrophic tubules, inflammation in >25% of total cortex, and other causes of i-IFTA ruled out. Banff 2015 named the entity in the vascular compartment only
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[0]0.95the tagger's words
senses`acute/active ABMR` (before 2017) vs `active ABMR` (2017 on) - THE SAME CATEGORY WITH A WORD DELETED, `because the term `acute` ... is confusing to clinicians`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[1]0.95the tagger's words
senses`i-IFTA` - `inflammation in areas of interstitial fibrosis and tubular atrophy`: `EXCLUDED from the classification` in 1991 for nonspecificity, admitted in 2017 in conjunction with tubulitis
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[2]0.95the tagger's words
senses`borderline` - a category that exists WITHIN acute TCMR and was deliberately NOT created for chronic active TCMR, because the existing one `has proved to be troublesome for treating clinicians and even for pathologists to define`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[3]0.95the tagger's words
claim_relationsextends → the Banff 2015 meeting report, which named chronic active TCMR in the vascular compartment but gave no criteria for the tubulointerstitial one
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
claim_relations[0]0.95the tagger's words
claim_relationsextends → the first Banff meeting of 1991, which specifically EXCLUDED i-IFTA and tubulitis in atrophic tubules from the classification - this report reverses that exclusion and gives the reason
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
claim_relations[1]0.95the tagger's words
concept_edgeschronic active TCMR —distinct-from→ acute TCMR
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
the relation itself is separately evidenced · strength of the relation: 0.95 · note: 'a biopsy fulfilling…' - the two categories are kept apart by a rule about co-diagnosis, not by a difference in lesion · the relation stated: the two categories are kept apart by a rule about CO-DIAGNOSIS: a biopsy meeting the chronic active criteria may NOT also be called Borderline or acute TCMR
concept_edges[0]0.95the tagger's words
concept_edgestitration —contrasted-with→ mean fluorescence intensity
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
the relation itself is separately evidenced · strength of the relation: 0.95 · note: 'TITRATION RATHER…' - two readouts of the same antibody, one preferred because the other has a ceiling. The instrument's dynamic range decides which number the endpoint is made of · the relation stated: two readouts of the same antibody, one preferred RATHER THAN the other because the other saturates
concept_edges[1]0.95the tagger's words
concept_edgesborderline —part-of→ acute TCMR
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
the relation itself is separately evidenced · strength of the relation: 0.85 · note: 'there is NO BORDERLINE…' - the borderline category belongs to acute TCMR and was deliberately withheld from the new one. Weight 0.85: the clause asserts the containment in a subordinate aside, in the course of denying its twin · the relation stated: the borderline category exists WITHIN acute TCMR - asserted in the aside that denies the same category to chronic active TCMR Audit 2026-09-28: DOUBTFUL - read against its span and kept, but the borderline category exists within acute TCMR; part-of is loose.
concept_edges[2]0.95the tagger's words
content_tagsTHE VOCABULARY'S OWN AUTHORS APPLY IT NON-UNIFORMLY, MEASURED AND PRINTED: `Survey among renal pathologists (including very experienced) revealed nonuniform application of current Banff TCMR cutoffs, consideration of non-Banff lesions in TCMR diagnosis, grading or nongrading of i-IFTA`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[0]0.95the tagger's words
content_tagsA WORD DELETED FROM A DIAGNOSTIC CLASSIFICATION FOR A COMMUNICATIVE REASON: `The term `ACUTE` (in acute/active ABMR) is confusing to clinicians, and consequently it has been removed from the Banff classification`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[1]0.95the tagger's words
content_tagsAND THE DIRECTION OF THE MISREADING IS NAMED: `Clinicians often fail to recognize chronic elements of ABMR` and are `more likely to consider a diagnosis of chronic, active ABMR if C4d is negative, even if there is no TG, PTCBML, or IFTA`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[2]0.95the tagger's words
content_tagsA FEATURE EXCLUDED IN 1991 AND ADMITTED IN 2017 BECAUSE THE POPULATION CHANGED: `The NONSPECIFICITY of i-IFTA for rejection, proved by the fact that it occurs in native kidneys, was the MAIN REASON WHY [it] WAS SPECIFICALLY EXCLUDED ... at the first Banff meeting. However, since 1991, immunosuppression has changed`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[3]0.95the tagger's words
content_tagsA CATEGORY DELIBERATELY NOT CREATED, WITH THE REASON GIVEN: `there is no borderline or suspicious category for chronic active TCMR, particularly as this category within acute TCMR has proved to be troublesome for treating clinicians and even for pathologists to define`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[4]0.95the tagger's words
content_tagsAND THE BIOMARKER OFFERED AS A TRIAL ENDPOINT CARRIES THE SAME DEFECT: `current shortcomings of DSA testing (variability in test methods, diagnostic threshold definitions, clinical significance standards) are known to limit its utility as a sole endpoint`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[5]0.95the tagger's words
content_tags`a combination of i-IFTA and tubulitis involving all but severely atrophic tubules, with moderately high thresholds for both (i-IFTA2-3; t2-3), a requirement for inflammation involving >25% of the total cortex present, and other differential diagnoses known to be associated with i-IFTA (eg, chronic pyelonephritis, BK nephropathy) being ruled out`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.definitions[0]0.95the tagger's words
content_tagsthe exclusion inside the criterion: tubulitis counts in all but severely atrophic tubules, so the lesion is defined partly by which tubules do not count
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.definitions[1]0.95the tagger's words
content_tags`complete agreement between all 3 PATHOLOGISTS IN 101 (67%) OF 150 CASES, and a KAPPA VALUE OF .62` - reported as `good agreement`, and the basis for admitting the lesion to the classification
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.quantities[0]0.95the tagger's words
content_tagsthe extent requirement that sits alongside the two score thresholds
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.quantities[1]0.95the tagger's words
content_tags`i-IFTA scores of 2 and 3, but not 1, as well as t2 and t3 tubulitis (but not t1) ... were associated with an increased rate of graft loss` - the class boundary drawn where the prognostic signal begins
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.quantities[2]0.95the tagger's words
content_tagsthe agreement statistic the new criterion rests on, at .62 across 3 pathologists and 150 cases
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: kappa
content_tags.statistics[0]0.95the tagger's words
content_tagsthe semiquantitative score whose threshold (2-3 rather than 1) decides whether a biopsy is chronic active TCMR
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: i-IFTA score
content_tags.variables[0]0.95the tagger's words

Interpretive choices

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