BRIEF RESEARCH REPORT article
Front. Nephrol.
Sec. Kidney Transplantation
Volume 5 - 2025 | doi: 10.3389/fneph.2025.1645280
This article is part of the Research TopicExploring kidney pathology in transplantation: Spotlight on non-neoplastic conditions and DCD donor qualityView all articles
Diagnostic Agreement and Limitations of the Banff Automated System in Kidney Transplant Biopsies
Provisionally accepted
Jun Matsushita1
Toshihito Hirai2*Tomokazu Shimizu2
Yu Kijima2Kohei Unagami2Masaaki Yanishi1Hidefumi Kinoshita1Toshio Takagi2Hideki Ishida2- 1Kansai Ika Daigaku, Hirakata, Japan
- 2Tokyo Women's Medical University, Shinjuku, Japan
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The Banff classification for renal allograft rejection has evolved over time, increasing in complexity. For non-pathologists conducting retrospective studies, assigning Banff diagnostic categories across different eras presents a significant challenge. The Automated Diagnosis System (ADS) is a publicly available web-based tool designed to standardize Banff category diagnoses based on Banff scoring. We retrospectively evaluated ADS using 1,071 kidney biopsy results from 544 transplant recipients, including 146 ABO-incompatible cases performed at our institution. Overall concordance between ADS and pathologists was 69.8%, with high agreement in non-rejection (97.4%) and rejection (86.3%) cases. Among rejection cases, discrepancies were noted in 27 antibody-mediated rejection (AMR) and 22 T cell-mediated rejection (TCMR) cases. Discrepancies were frequently observed in AMR following ABOincompatible transplantation and in chronic TCMR, highlighting challenges in standardizing these categories. Despite these limitations, ADS demonstrated acceptable concordance and potential utility for promoting global standardization in rejection diagnosis.
Keywords: Kidney Transplantation, Banff automated diagnosis system, ABO incompatible kidney transplant, Antibody mediated rejection, T-cell mediated rejection
Received: 11 Jun 2025; Accepted: 15 Aug 2025.
Copyright: © 2025 Matsushita, Hirai, Shimizu, Kijima, Unagami, Yanishi, Kinoshita, Takagi and Ishida. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Toshihito Hirai, Tokyo Women's Medical University, Shinjuku, Japan
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