The Banff Conferences on Allograft Pathology
1991 - Present

History and General information about the Banff Conferences on Allograft Pathology, the Banff Consensus Process and Funding

On December 18th, 1990
I received a letter from Paul Keown telling me that the ISHLT had just published a consensus classification of heart and lung transplant biopsy interpretation and suggesting that we do the same for the kidney.  I was enthusiastic from the beginning and so was Lorraine Racusen who said it was the most interesting project I had ever suggested to her.  We decided to undertake it together and I began to look around for a location for the meeting.
My wife Elaine had been to conferences at the Banff Centre and suggested that as a venue.  On Easter Sunday in April 1991 we happened to be in Banff and on a whim I stopped by the Banff Centre.  The office was open despite the holiday because they were running a conference that day and so we began planning the meeting there for the first week of August.
The first meeting was very small.  Actually it was interdigitated with a ISN Disaster Relief Task Force meeting which I conducted the same weekend.  The people involved in the the transplant pathology meeting included Paul Keown, Bryan Myers, Lennie Ramos, Pekka Hayry, Eva von Willebrand, Steen Olsen, Byron Croker, Phil Halloran, Margaret Billingham, Doug Wilson, Lorraine Racusen, and me.  You can see a video here (Banff Faces video).
The main genesis of the idea of the new classification came from the joint observations Steen Olsen and I had made on protocol biopsies.  At Steen's hospital protocol biopsies were carried out in every transplant before discharge from the hospital and then often later in the transplant course.  The protocol biopsy studies from Aarhus played an important role in our thinking about thresholds for rejection, especially with regard to tubulitis.
The protocol biopsy study which James Burdick and I conducted at Johns Hopkins began in January 1983 continued until I moved to Canada in 1987.
The articles below reflect these protocol biopsy studies that were an important background and the main motivation for the creation of the Banff schema in 1991:
Transplantation. 1984 Dec;38(6):679-84.

Characteristics of early routine renal allograft biopsies.
Burdick JF, Beschorner WE, Smith WJ, McGraw D, Bender WL, Williams GM, Solez K.
The assumption that renal allograft histology should be perfectly normal during quiescence in the absence of rejection or nephrotoxic insults has not been adequately investigated. To study this, routine renal allograft biopsies were performed at approximately 1 and 4 weeks, when patients often had normal function or stable acute tubular necrosis (ATN). These were compared with biopsies from other patients during autologous ATN or clinically evident allograft rejection. There were two new findings: (1) Almost all biopsies contained an interstitial infiltrate, so that only the presence of vasculitis provided a clear distinction between rejection and quiescence. Most of the biopsies with infiltrates were from patients who had never received cyclosporine, so that an infiltrate does not necessarily signify toxicity due to this drug. (2) A major proportion of the cells in some biopsies appeared to express both the helper/inducer and the cytotoxic/suppressor phenotype, and a similar finding after in vitro stimulation suggests that this represents a cell population that is activated in some way.

Medicine (Baltimore). 1989 May;68(3):173-87.

Primary acute renal failure ("acute tubular necrosis") in the transplanted kidney: morphology and pathogenesis.
Olsen S, Burdick JF, Keown PA, Wallace AC, Racusen LC, Solez K.
University Institute of Pathology, Aarhus Kommunehospital, Denmark.
"Acute tubular necrosis" (ATN) in the transplanted kidney, when properly differentiated from other causes of acute renal failure, appears to be a relatively benign condition. It has been widely assumed to be pathologically identical to ATN in the native kidney, but its histopathologic features have not been studied in detail. Because immunosuppressive therapy with cyclosporine adds an additional layer of complexity to the morphologic changes observed, in the present study we have confined our observations to patients immunosuppressed with steroids and azathioprine. Thirteen renal allograft biopsies from patients with ATN and 5 biopsies from patients with normal allograft function were compared with the previously obtained series of 57 native kidney ATN biopsies and 20 control biopsies. Both qualitative and quantitative differences between transplant and native kidney ATN were found. Compared with native kidney ATN, transplant ATN showed significantly less thinning and absence of proximal tubular brush border and less variation in size and shape of cells in individual tubular cross-sections. There were also significantly fewer casts and less dilatation of Bowman's space and a significantly greater number of polarizable crystals presumed to be oxalate in transplant ATN. In native kidney ATN the tubular injury sites were mostly characterized by desquamation of individual epithelial cells leaving areas of bare basement membrane (the "non-replacement" phenomenon). In transplant ATN, sites of tubular injury, although rare and affecting only short tubular segments, were characterized by the actual presence of identifiable necrotic tubular cells, a finding seldom seen in native kidney ATN. There also was a greater interstitial infiltrate of mononuclear inflammatory cells in transplant ATN compared to native kidney ATN. Electron microscopic studies of 9 transplant ATN biopsies showed a mild reduction in proximal tubular brush border compared with controls but this alteration was significantly less than that observed in native kidney ATN. There was no significant alteration in proximal or distal basolateral infoldings and this contrasted sharply with the marked reduction in basolateral infoldings of the plasma membrane observed in native kidney ATN. Disintegrated necrotic cells were found by electron microscopy in transplant ATN whereas these were not observed in native kidney ATN. There were significantly more cells with apoptosis (shrinkage necrosis) in transplant ATN than in native kidney ATN. There were significantly more cells with apoptosis (shrinkage necrosis) in transplant ATN than in native kidney ATN. On the other hand, there were significantly greater numbers of "non-replacement" sites in the distal tubules in native kidney ATN compared to transplant ATN.

It was clear to us that interstitial inflammation by itself was completely nonspecific and did not constitute rejection unless accompanied by substantial tubulitis beyond a certain threshold or by arteritis.  This message of the nonspecificity of interstitial infiltrate alone was considered so important in the description of the new classification that the editor of KI insisted that we emphasize this very early in the manuscript ("so it will be seen and understood even by the reader who never gets beyond the first page"). The published paper in 1993 reflected this suggested structure.
One can follow the progress of the meeting through its publications. There was a significant flaw in the original 1993 paper: it regarded tubulitis in atrophic tubules as having the same significance as tubulitis in nonatrophic tubules.  By 1995 it became common practice to score tubulitis only in nonatrophic tubules and this requirement became part of the Banff 1997 classification published in 1999.
The 1995 meeting focused on making the Banff lesion scoring the same as CADI so there was no difference between the two assessments.  The 1997 meeting modified the classification so that the concepts of the Banff and the NIH CCTT classifications were aligned and the two were merged in the 1997 Banff Working Classification.
More recently the classification has incorporate antibody mediated rejection and has begun to address genomics, telepathology, maintenance of competence and training courses, and many other subjects.  The Banff conferences have attracted an increasingly wide assortment of stakeholders to the meeting including pathologists, clinicians, surgeons, basic scientists, and representatives of other important organizations in transplantation like the ISHLT and the Immune Tolerance Network, regulatory agencies and government bodies, and pharmaceutical companies.
Constant vigilance has been necessary over these past 18 years to maintain the scientific rigor the meeting required.  Often that rigor came mainly from the program we put together for the meeting, the selections of speakers and the goals and objectives for the meeting, the ideas about what each meeting should try to accomplish and who should lead various aspects of the process.  Lorraine Racusen was the prime mover in these aspects of the meeting many years emphasizing cutting edge topics in transplantation.  In addition to formal seminar-style sessions and facilitated discussions, poster sessions have provided an excellent format for data presentation and networking for both junior and senior investigators.
Other solid organs beyond the kidney have always been there at the Banff meetings. Margaret Billingham represented the heart in the first meeting in 1991, but the other organs have become increasingly active in recent years creating their own Banff classifications of their respective areas, or moving the science of transplantation along by improving existing classifications.
There are now Banff classifications of liver, pancreas and composite tissue allograft pathology.  We are most grateful to those who have led these non-renal areas of the meeting, Jake Demetris in liver, Cynthia Drachenberg in pancreas, Rene Rodriguez in heart, and Linda Cendales in composite tissue.

The Banff  Consensus Process

In 1991 I had three years of experience in leading the consensus process that a year later resulted in the Final Report of the Future of Pathology and Laboratory Medicine in Canada Consortium, so consensus generation in the allograft pathology meetings was conducted in a similar fashion.
There was no professional facilitator.  In the beginning I did most of the facilitation.  In later years Lorraine Racusen, Bob Colvin, and sessions chairs have also played an important role in facilitation.
The other solid organs - liver, pancreas, composite tissue, heart, lung - have tended to follow the structure of the kidney consensus process in their own deliberations at the meeting.
The author line in the manuscripts reflected the actual work of creating them, with the individuals who facilitated and structured discussions at the meeting and who actually wrote the paper being included first, and the other authors being listed alphabetically after that.
Authorship included everyone who provided substantive and useful input, even those who were not at the meeting. From the beginning we have favored participation by young people, and those from developing countries.  There has been a successful effort from the start to make the classification truly international.
An amusing aside is that in the beginning most feedback on the papers was provided by fax and in the years 1991-93 I spent about $15,000 a year on fax charges.  With the advent of Email this cost dropped to essentially zero by 1994.

Funding for the Banff Meetings

Funding for the Banff meetings has been unusual in a very positive way from the very beginning: Those involved in organizing the meeting donate their time and are supported from elsewhere so there are essentially no administrative costs. Also from the beginning many speakers paid their own way to the meeting or found their own support.
Michele Hales who coordinated the Banff meetings from 1991 to 2007 had a University of Alberta position supported by the National Kidney Foundation (US) as Assistant Director of NKF cyberNephrology, a joint project of the University and the NKF.
Victoria Sheldon who has coordinated the Banff meetings since 2007 is a full time University undergraduate student and a part time employee of Transpath Inc.
Corporate donations to the Banff meetings are made payable to the University of Alberta and kept in a University account with all the usual oversights required by University procedures.  Copies of past budgets are available on request.  I (Kim Solez) am the contact for corporate donations, assisted by Dr. Michael Mengel and Victoria Sheldon.  Corporate donors are acknowledged on the website for the meeting, in the printed program, and in the publications from the Banff meetings.
As noted, most speakers cover their own costs.  This arrangement has worked well for eighteen years and allows us to put on a consistently excellent, unique standard-setting meeting while keeping costs to a minimum.
We are particularly enthusiastic about providing financial assistance to young participants and those from countries that have not been represented in the past in the process.
I hope this background description is useful to you and that you enjoy the other facets of the website.

Thanks to Everyone!

Finally I would like to thank everyone involved for the financial assistance we have received from individuals, corporations and granting agencies over the post 18 years.  We could not have done it without you!
The intellectual ferment of Banff is even more important, and for this I thank all of you who have contributed your time and ideas over the years to help us make important new decisions and move science and medical practice forward.
The next eighteen years will be even more exciting than the past eighteen have been, as our activities expand still further.  Thanks to everyone for participating and contributing!

Yours sincerely,

Kim Solez, M.D.
Director of Banff Conferences for Allograft Pathology
Cell phone: 780-710-1644

Copyright 1991 - 2013 Banff Conferences on Allograft Pathology All rights reserved. 
Last Modified: November 04, 2016 03:28:19 PM