BANFF 2022 PANCREAS TRANSPLANTATION MULTIDISCIPLINARY REPORT: Refinement of guidelines for TCMR, AMR, islet and non-rejection pathologies. Assessment of duodenal cuff biopsies and non-invasive diagnostic methods.
Academic Article
Overview
abstract
The Banff pancreas working schema for diagnosis and grading of rejection is widely used for treatment guidance and risk stratification in centers that perform pancreas allograft biopsies. Since the last update, various studies have provided additional insight regarding the application of the schema and enhanced our understanding of additional clinicopathological entities. This update aims to clarify terminology and lesion description for T-cell mediated and antibody mediated allograft rejections, in both active and chronic forms. In addition, morphological and immunohistochemical tools are described to help distinguish rejection from non-rejection pathologies. For the first time, a clinicopathological approach to islet pathology in the early and late post-transplant periods is discussed. This update also includes a discussion and recommendations on the utilization of endoscopic duodenal donor cuff biopsies as surrogates for pancreas biopsies in various clinical settings. Finally, an analysis and recommendations on the use of donor derived cell free DNA for monitoring pancreas graft recipients is provided. This multidisciplinary effort assesses the current role of pancreas allograft biopsies, and offers practical guidelines that can be helpful to pancreas transplant practitioners as well as experienced pathologists and pathologists in training.
