Abstract

Background: The Banff working expression of renal transplant pathology is intended to have transnational operation. There remains a need to develop styles to harmonize the operation of similar grading systems between laboratories. Banff grades don't always permit precise operation opinions to be made. Indispensable schemes have been cooked for the opinion of acute rejection, but there have been no independent tests of the different approaches.

Method: Sections from 55 renal transplant necropsies were circulated around the laboratories of 22 major transplant units for the Confluence of European Renal Transplant Pathology Assessment Procedures (CERTPAP) design. Sharing pathologists were asked to grade 32 different histological features, without any clinical information. After each rotation of five cases, feedback was handed to actors. Statistical substantiation of enhancement in interobserver variation was sought. At the end of the study, correlations with the original clinic pathological opinion were sought.

Results: Interobserver variation was lesser than has preliminarily been reported. For every point studied, some pathologists constantly under- grade orover-grade. There was fairly little substantiation of enhancement in interobserver variation as a result of the feedback system. No single point permitted a dependable opinion of acute rejection. Applying the Banff and CCTT schemas to the histological grades showed no clear individual advantage for either system, but a simple computer- grounded conclusion network, which combined data from 12 histological features, outperformed either approach. Within the “protocol” necropsies studied, long- term survival identified better with “acute” than with “habitual” histological features.

Conclusions: These results don't undermine the value of the Banff bracket, but they demonstrate a need for caution when rephrasing vivisection results between institutions. It's egregious that evaluation of necropsies in multicenter trials must be done in one center. In the operation of individual cases, the need to interpret Banff grades in the light of original experience and clinical information is stressed