Banff 2022 Liver Group Meeting report: Monitoring long-term allograft health

Christopher O.C. Bellamy; Jacqueline G. O'Leary; Oyedele Adeyi; Nahed Baddour; Ibrahim Batal; John Bucuvalas; Arnaud Del Bello; Mohamed El Hag; Magda El-Monayeri; Alton B. Farris; Sandy Feng; Maria Isabel Fiel; Sandra E. Fischer; John Fung; Krzysztof Grzyb; Maha Guimei; Hironori Haga; John Hart; Annette M. Jackson; Elmar Jaeckel; Nigar Anjuman Khurram; Stuart J. Knechtle; Drew Lesniak; Josh Levitsky; Geoff McCaughan; Catriona McKenzie; Claudia Mescoli; Rosa Miquel; Marta I. Minervini; Imad Ahmad Nasser; Desley Neil; Maura F. O'Neil; Orit Pappo; Parmjeet Randhawa; Phillip Ruiz; Alberto Sanchez Fueyo; Deborah Schady; Thomas Schiano; Mylene Sebagh; Maxwell Smith; Heather L. Stevenson; Timucin Taner; Richard Taubert; Swan Thung; Pavel Trunecka; Hanlin L. Wang; Michelle Wood-Trageser; Funda Yilmaz; Yoh Zen; Adriana Zeevi; Anthony J. Demetris

doi:10.1016/j.ajt.2024.03.008

Banff 2022 Liver Group Meeting report: Monitoring long-term allograft health

Christopher O.C. Bellamy^*, Jacqueline G. O'Leary, Oyedele Adeyi, Nahed Baddour, Ibrahim Batal, John Bucuvalas, Arnaud Del Bello, Mohamed El Hag, Magda El-Monayeri, Alton B. Farris, Sandy Feng, Maria Isabel Fiel, Sandra E. Fischer, John Fung, Krzysztof Grzyb, Maha Guimei, Hironori Haga, John Hart, Annette M. Jackson, Elmar JaeckelNigar Anjuman Khurram, Stuart J. Knechtle, Drew Lesniak, Josh Levitsky, Geoff McCaughan, Catriona McKenzie, Claudia Mescoli, Rosa Miquel, Marta I. Minervini, Imad Ahmad Nasser, Desley Neil, Maura F. O'Neil, Orit Pappo, Parmjeet Randhawa, Phillip Ruiz, Alberto Sanchez Fueyo, Deborah Schady, Thomas Schiano, Mylene Sebagh, Maxwell Smith, Heather L. Stevenson, Timucin Taner, Richard Taubert, Swan Thung, Pavel Trunecka, Hanlin L. Wang, Michelle Wood-Trageser, Funda Yilmaz, Yoh Zen, Adriana Zeevi, Anthony J. Demetris

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

The Banff Working Group on Liver Allograft Pathology met in September 2022. Participants included hepatologists, surgeons, pathologists, immunologists, and histocompatibility specialists. Presentations and discussions focused on the evaluation of long-term allograft health, including noninvasive and tissue monitoring, immunosuppression optimization, and long-term structural changes. Potential revision of the rejection classification scheme to better accommodate and communicate late T cell-mediated rejection patterns and related structural changes, such as nodular regenerative hyperplasia, were discussed. Improved stratification of long-term maintenance immunosuppression to match the heterogeneity of patient settings will be central to improving long-term patient survival. Such personalized therapeutics are in turn contingent on a better understanding and monitoring of allograft status within a rational decision-making approach, likely to be facilitated in implementation with emerging decision-support tools. Proposed revisions to rejection classification emerging from the meeting include the incorporation of interface hepatitis and fibrosis staging. These will be opened to online testing, modified accordingly, and subject to consensus discussion leading up to the next Banff conference.

Original language	English (US)
Pages (from-to)	905-917
Number of pages	13
Journal	American Journal of Transplantation
Volume	24
Issue number	6
DOIs	https://doi.org/10.1016/j.ajt.2024.03.008
State	Published - Jun 2024

Funding

Annette Jackson reports financial support was provided by Hansa Biopharma AB. Annette Jackson reports equipment, drugs, or supplies was provided by CareDx Inc. Annette Jackson reports financial support was provided by One Lambda Inc. Josh Levitsky reports financial support was provided by eGenesis. Josh Levitsky reports financial support was provided by Eurofins Scientific SE. Josh Levitsky reports financial support was provided by Mallinckrodt. Josh Levitsky reports financial support was provided by Takeda Pharmaceutical Company Limited. Richard Taubert reports equipment, drugs, or supplies was provided by OncoCyte Corporation. Richard Taubert reports equipment, drugs, or supplies was provided by Chronix Biomedical Inc. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. These are documented in planned biopsies of both pediatric and adult recipients, the former benefitting from a relative lack of recurrent disease to confound interpretation of such changes for cause. Putting aside early and potentially “technical” complications, such as anastomotic biliary strictures, the most prevalent documented parenchymal changes in clinically stable pediatric allografts have been fibrosis and interface hepatitis (IH).7 Progressive allograft fibrosis is preceded, accompanied, and predicted by IH,8 which is itself associated with mild aminotransferase flares and tissue transcriptomic signatures consistent with rejection.9 Serologic evidence of class II anti-Human Leucocyte antigen (HLA) donor-specific antibodies (DSA) and tissue demonstration of microvascular complement activation support a pathogenic role for antibody-mediated alloimmunity. 9-11 DSA can also recruit effector cells into the liver allograft, perhaps via complement-mediated allostimulatory effects on antigen-presenting cells,12 which may explain the RNA signature of T cell-mediated rejection (TCMR) found in most patients with DSA in serum.9,13 This constellation of findings was recognized by the introduction of guidelines for the diagnosis of chronic antibody-mediated rejection (AMR) in the 2016 update of the Banff Working Group on Liver Allograft Pathology.14

Keywords

Banff classification
T cell-mediated rejection
alloimmunity
anatomy
antibody-mediated rejection
immunosuppression
liver transplantation
pathology
protocol biopsy

ASJC Scopus subject areas

Immunology and Allergy
Transplantation
Pharmacology (medical)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.ajt.2024.03.008

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Bellamy, C. O. C., O'Leary, J. G., Adeyi, O., Baddour, N., Batal, I., Bucuvalas, J., Del Bello, A., El Hag, M., El-Monayeri, M., Farris, A. B., Feng, S., Fiel, M. I., Fischer, S. E., Fung, J., Grzyb, K., Guimei, M., Haga, H., Hart, J., Jackson, A. M., ... Demetris, A. J. (2024). Banff 2022 Liver Group Meeting report: Monitoring long-term allograft health. American Journal of Transplantation, 24(6), 905-917. https://doi.org/10.1016/j.ajt.2024.03.008

@article{1bb412a647bd45ff8481cc31008212c0,

title = "Banff 2022 Liver Group Meeting report: Monitoring long-term allograft health",

abstract = "The Banff Working Group on Liver Allograft Pathology met in September 2022. Participants included hepatologists, surgeons, pathologists, immunologists, and histocompatibility specialists. Presentations and discussions focused on the evaluation of long-term allograft health, including noninvasive and tissue monitoring, immunosuppression optimization, and long-term structural changes. Potential revision of the rejection classification scheme to better accommodate and communicate late T cell-mediated rejection patterns and related structural changes, such as nodular regenerative hyperplasia, were discussed. Improved stratification of long-term maintenance immunosuppression to match the heterogeneity of patient settings will be central to improving long-term patient survival. Such personalized therapeutics are in turn contingent on a better understanding and monitoring of allograft status within a rational decision-making approach, likely to be facilitated in implementation with emerging decision-support tools. Proposed revisions to rejection classification emerging from the meeting include the incorporation of interface hepatitis and fibrosis staging. These will be opened to online testing, modified accordingly, and subject to consensus discussion leading up to the next Banff conference.",

keywords = "Banff classification, T cell-mediated rejection, alloimmunity, anatomy, antibody-mediated rejection, immunosuppression, liver transplantation, pathology, protocol biopsy",

author = "Bellamy, {Christopher O.C.} and O'Leary, {Jacqueline G.} and Oyedele Adeyi and Nahed Baddour and Ibrahim Batal and John Bucuvalas and {Del Bello}, Arnaud and {El Hag}, Mohamed and Magda El-Monayeri and Farris, {Alton B.} and Sandy Feng and Fiel, {Maria Isabel} and Fischer, {Sandra E.} and John Fung and Krzysztof Grzyb and Maha Guimei and Hironori Haga and John Hart and Jackson, {Annette M.} and Elmar Jaeckel and Khurram, {Nigar Anjuman} and Knechtle, {Stuart J.} and Drew Lesniak and Josh Levitsky and Geoff McCaughan and Catriona McKenzie and Claudia Mescoli and Rosa Miquel and Minervini, {Marta I.} and Nasser, {Imad Ahmad} and Desley Neil and O'Neil, {Maura F.} and Orit Pappo and Parmjeet Randhawa and Phillip Ruiz and Fueyo, {Alberto Sanchez} and Deborah Schady and Thomas Schiano and Mylene Sebagh and Maxwell Smith and Stevenson, {Heather L.} and Timucin Taner and Richard Taubert and Swan Thung and Pavel Trunecka and Wang, {Hanlin L.} and Michelle Wood-Trageser and Funda Yilmaz and Yoh Zen and Adriana Zeevi and Demetris, {Anthony J.}",

note = "Publisher Copyright: {\textcopyright} 2024",

year = "2024",

month = jun,

doi = "10.1016/j.ajt.2024.03.008",

language = "English (US)",

volume = "24",

pages = "905--917",

journal = "American Journal of Transplantation",

issn = "1600-6135",

publisher = "Elsevier B.V.",

number = "6",

}

Bellamy, COC, O'Leary, JG, Adeyi, O, Baddour, N, Batal, I, Bucuvalas, J, Del Bello, A, El Hag, M, El-Monayeri, M, Farris, AB, Feng, S, Fiel, MI, Fischer, SE, Fung, J, Grzyb, K, Guimei, M, Haga, H, Hart, J, Jackson, AM, Jaeckel, E, Khurram, NA, Knechtle, SJ, Lesniak, D, Levitsky, J, McCaughan, G, McKenzie, C, Mescoli, C, Miquel, R, Minervini, MI, Nasser, IA, Neil, D, O'Neil, MF, Pappo, O, Randhawa, P, Ruiz, P, Fueyo, AS, Schady, D, Schiano, T, Sebagh, M, Smith, M, Stevenson, HL, Taner, T, Taubert, R, Thung, S, Trunecka, P, Wang, HL, Wood-Trageser, M, Yilmaz, F, Zen, Y, Zeevi, A & Demetris, AJ 2024, 'Banff 2022 Liver Group Meeting report: Monitoring long-term allograft health', American Journal of Transplantation, vol. 24, no. 6, pp. 905-917. https://doi.org/10.1016/j.ajt.2024.03.008

TY - JOUR

T1 - Banff 2022 Liver Group Meeting report

T2 - Monitoring long-term allograft health

AU - Bellamy, Christopher O.C.

AU - O'Leary, Jacqueline G.

AU - Adeyi, Oyedele

AU - Baddour, Nahed

AU - Batal, Ibrahim

AU - Bucuvalas, John

AU - Del Bello, Arnaud

AU - El Hag, Mohamed

AU - El-Monayeri, Magda

AU - Farris, Alton B.

AU - Feng, Sandy

AU - Fiel, Maria Isabel

AU - Fischer, Sandra E.

AU - Fung, John

AU - Grzyb, Krzysztof

AU - Guimei, Maha

AU - Haga, Hironori

AU - Hart, John

AU - Jackson, Annette M.

AU - Jaeckel, Elmar

AU - Khurram, Nigar Anjuman

AU - Knechtle, Stuart J.

AU - Lesniak, Drew

AU - Levitsky, Josh

AU - McCaughan, Geoff

AU - McKenzie, Catriona

AU - Mescoli, Claudia

AU - Miquel, Rosa

AU - Minervini, Marta I.

AU - Nasser, Imad Ahmad

AU - Neil, Desley

AU - O'Neil, Maura F.

AU - Pappo, Orit

AU - Randhawa, Parmjeet

AU - Ruiz, Phillip

AU - Fueyo, Alberto Sanchez

AU - Schady, Deborah

AU - Schiano, Thomas

AU - Sebagh, Mylene

AU - Smith, Maxwell

AU - Stevenson, Heather L.

AU - Taner, Timucin

AU - Taubert, Richard

AU - Thung, Swan

AU - Trunecka, Pavel

AU - Wang, Hanlin L.

AU - Wood-Trageser, Michelle

AU - Yilmaz, Funda

AU - Zen, Yoh

AU - Zeevi, Adriana

AU - Demetris, Anthony J.

PY - 2024/6

Y1 - 2024/6

N2 - The Banff Working Group on Liver Allograft Pathology met in September 2022. Participants included hepatologists, surgeons, pathologists, immunologists, and histocompatibility specialists. Presentations and discussions focused on the evaluation of long-term allograft health, including noninvasive and tissue monitoring, immunosuppression optimization, and long-term structural changes. Potential revision of the rejection classification scheme to better accommodate and communicate late T cell-mediated rejection patterns and related structural changes, such as nodular regenerative hyperplasia, were discussed. Improved stratification of long-term maintenance immunosuppression to match the heterogeneity of patient settings will be central to improving long-term patient survival. Such personalized therapeutics are in turn contingent on a better understanding and monitoring of allograft status within a rational decision-making approach, likely to be facilitated in implementation with emerging decision-support tools. Proposed revisions to rejection classification emerging from the meeting include the incorporation of interface hepatitis and fibrosis staging. These will be opened to online testing, modified accordingly, and subject to consensus discussion leading up to the next Banff conference.

AB - The Banff Working Group on Liver Allograft Pathology met in September 2022. Participants included hepatologists, surgeons, pathologists, immunologists, and histocompatibility specialists. Presentations and discussions focused on the evaluation of long-term allograft health, including noninvasive and tissue monitoring, immunosuppression optimization, and long-term structural changes. Potential revision of the rejection classification scheme to better accommodate and communicate late T cell-mediated rejection patterns and related structural changes, such as nodular regenerative hyperplasia, were discussed. Improved stratification of long-term maintenance immunosuppression to match the heterogeneity of patient settings will be central to improving long-term patient survival. Such personalized therapeutics are in turn contingent on a better understanding and monitoring of allograft status within a rational decision-making approach, likely to be facilitated in implementation with emerging decision-support tools. Proposed revisions to rejection classification emerging from the meeting include the incorporation of interface hepatitis and fibrosis staging. These will be opened to online testing, modified accordingly, and subject to consensus discussion leading up to the next Banff conference.

KW - Banff classification

KW - T cell-mediated rejection

KW - alloimmunity

KW - anatomy

KW - antibody-mediated rejection

KW - immunosuppression

KW - liver transplantation

KW - pathology

KW - protocol biopsy

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UR - http://www.scopus.com/inward/citedby.url?scp=85188418055&partnerID=8YFLogxK

U2 - 10.1016/j.ajt.2024.03.008

DO - 10.1016/j.ajt.2024.03.008

M3 - Article

C2 - 38461883

AN - SCOPUS:85188418055

SN - 1600-6135

VL - 24

SP - 905

EP - 917

JO - American Journal of Transplantation

JF - American Journal of Transplantation

IS - 6

ER -

Banff 2022 Liver Group Meeting report: Monitoring long-term allograft health

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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