Real-time monitoring of acute liver-allograft rejection using the banff schema

A. Juan Demetris, K. Ruppert, I. Dvorchik, A. Jain, M. Minervini, M. A. Nalesnik, P. Randhawa, T. Wu, A. Zeevi, K. Abu-Elmagd, B. Eghtesad, P. Fontes, T. Cacciarelli, W. Marsh, D. Geller, J. J. Fung

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84 Scopus citations


Background. The Banff schema is the internationally accepted standard for grading acute liver-allograft rejection, but it has not been prospectively tested. Methods. Complete Banff grading was prospectively applied to 2,038 liver-allograft biopsies from 901 adult tacrolimus-treated primary hepatic allograft recipients between August 1995 and September 2001. Histopathologic data was melded with demographic, clinical, and laboratory data into a database on an ongoing basis using locally developed software. Results. Acute rejection developed in 575 of 901 (64%) patients and the worst grade was mild in 422 of 575 (73%). At least one episode of moderate or severe acute rejection developed in 153 of 901 (17%) patients and most episodes, irrespective of severity, occurred within the first year after transplantation. Patients with moderate or severe acute rejection showed higher alanine aminotransferase (P=0.007) and aspartate aminotransferase (P=0.07) levels and were more likely to develop perivenular fibrosis on follow-up biopsies (P=0.001) and graft failure from acute or chronic rejection (P=0.004) than those with mild rejection. Regardless of severity, 80% of patients with acute rejection did not develop significant fibrosis in follow-up biopsies, and graft failure from acute or chronic rejection occurred in only 11 of 901 (1%) allografts. Conclusions. Most acute-rejection episodes are mild and do not lead to clinically significant architectural sequelae. When tested prospectively under real-life and -time conditions, the Banff schema can be used to identify those few patients who are potentially at risk for more significant problems. Creation, capture, and integration of non-free text, or "digital," pathology data can be used to prospectively conduct outcomes-based research in transplantation.

Original languageEnglish (US)
Pages (from-to)1290-1296
Number of pages7
Issue number9
StatePublished - Nov 15 2002

All Science Journal Classification (ASJC) codes

  • Transplantation


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