Evolution of human kidney allograft pathology diagnostics through 30 years of the Banff classification process

Table 3 Main changes in the nomenclature and classification of antibody-mediated rejection in the Banff classification over three decades of evolution (1991 to 2019)

Meeting reports, year	Category 2: Antibody-mediated rejection1
Banff, 1993	Hyperacute rejection
Banff, 1997	AMR3
	Hyperacute
	Accelerated acute3
Banff, 1997 update (2001)	Diagnostic criteria for acute antibody-mediated rejection were developed. Three types were described as: (1) Types I: ATN-like3; (2) Types II: Capillary3; and (3) Type III: Arterial3
Banff, 2005	Diagnostic criteria for chronic antibody-mediated rejection were developed
Banff, 2007	Antibody-mediated changes2,3
	C4d deposition without rejection3
	Acute antibody-mediated rejection
	Chronic active3 antibody-mediated rejection
Banff, 2013	Antibody-mediated changes
	Acute/active antibody-mediated rejection
	Chronic active antibody-mediated rejection
	C4d-negative antibody3-mediated rejection
Banff, 2015	Antibody-mediated changes
	Acute/active3 antibody-mediated rejection
	Chronic active antibody-mediated rejection
	C4d staining without evidence of rejection
	Transplant arteriopathy may be seen in chronic AMR
Banff, 2017	Antibody-mediated changes
	Active3 AMR
	Chronic active AMR
	C4d staining without evidence of rejection
	3 criteria for AMR diagnosis remain but C4d can substitute for DSA
	DSA testing still advised
	Suspicious for AMR eliminated
Banff, 2019	Category 2: Antibody-mediated changes
	Active AMR
	Chronic active AMR
	Chronic (inactive) AMR3
	C4d staining without evidence of rejection

¹May coincide with categories 3, 4 and 5 and 6;

²With the identification of c4d positivity without rejection, the category name was changed from rejection to changes);

³Changes in the nomenclature or criteria. AMR: Antibody-mediated rejection; ATN: Acute tubular necrosis; DSA: Donor-specific antibody.