HDCN Article Review/Hyperlink

Schweitzer EJ, Drachenberg CB, Anderson L, Papadimetriou JC, et al

Significance of the Banff borderline biopsy

Am J Kidney Dis (Oct) 28:585-588 1996

The Banff classification was developed to standardize the nomenclature and histologic criteria for acute renal allograft rejection. It has been the subject of considerable clinical incertitude among physicians who have to decide what if any treatment is appropriate for the "borderline" classification. This "gray zone" was arbitrarily defined as tubulitis with " >4 mononuclear cells per tubular cross section or group of 10 tubular cells and >25% interstitial infiltration." The recommendation that no treatment is a possible approach for this biopsy classification has been widely rejected.

This retrospective study initially examined 351 biopsies from 170 kidneys, eighty-one of which were labeled "borderline" by Banff criteria. Further review of the records left only 33 patients who appeared to have no confounding variables (infection, subtherapeutic drug levels, pre- renal azotemia, etc.) and were treated for possible acute rejection. The mean starting creatinine was 3.3 +/- 0.2 mg/dL before the initiation of standard anti-rejection therapy. Of this "borderline" group, fully 88% (29) had an improvement in serum creatinine after the start of treatment with mean values nearly baseline at 2.2 +/- 0.1 mg/dL at one month.

Comment: While this study does not account for natural history due to its lack of a control group without prospective randomization, it supports the prevailing view that most "borderline" biopsies are probably worthy of treatment. The Banff criteria serve as a useful tool in the scoring and recording of the separate elements of rejection for clinical trials. However, the scoring schema must be interpreted in the light of the clinical milieu. (Sri Narsipur, MD, SUNY-HSC at Syracuse, NY)