Expanding role of antibodies in kidney transplantation

Table 3 Main updates in the nomenclature and classification of antibody-mediated rejection in the Banff classification (1991 to 2019)

Banff meetings, years	Category 2 Antibody-mediated rejection1	Basis of diagnosis and classification
Banff ‘93	Hyperacute rejection	Clinical criteria only
Banff ‘97	Antibody-mediated rejection (AMR)
	Hyperacute
	Accelerated acute
Banff ’97 update (2001)	Diagnostic criteria for acute antibody-mediated rejection were developed	Histological criteria
	Three types were described as: Types I. ATN-like; II. Capillary; III. Arterial	Immunohistopathological criteria
		Serological criteria
Banff ‘05	Diagnostic criteria for chronic antibody-mediated rejection were developed
Banff ‘07	Antibody-mediated changes2
	C4d deposition without rejection
	Acute antibody-mediated rejection
	Chronic active antibody-mediated rejection
Banff ‘13	Antibody-mediated changes
	Acute/active antibody-mediated rejection	Histological
	Chronic active antibody-mediated rejection	Immunohistopathological
	C4d-negative antibody-mediated rejection	Serological
Banff ‘15	Antibody-mediated changes	Molecular criteria
	Acute/active antibody-mediated rejection
	Chronic active antibody-mediated rejection
	C4d staining without evidence of rejection
	Transplant arteriopathy may be seen in chronic
	AMR
Banff ‘17	Antibody-mediated changes
	Active 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 ‘19	Category 2: Antibody-mediated changes	Histological
	Active ABMR	Immunohistopathological
	Chronic active ABMR	Serological
	Chronic (inactive) ABMR	Molecular criteria
	C4d staining without evidence of rejection	Electron microscopy

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.

Changes in the nomenclature or criteria are in bold face.