The Banff Working Group Classification of Definitive Polyomavirus Nephropathy: Morphologic Definitions and Clinical Correlations.

Authors:
Volker Nickeleit
Volker Nickeleit
University of North Carolina
United States
Harsharan K Singh
Harsharan K Singh
The University of North Carolina School of Medicine
Chapel Hill | United States
Parmjeet Randhawa
Parmjeet Randhawa
University of Pittsburgh
Pittsburgh | United States
Cinthia B Drachenberg
Cinthia B Drachenberg
University of Maryland School of Medicine
United States
Ramneesh Bhatnagar
Ramneesh Bhatnagar
School of Medicine
Baltimore | United States
Erika Bracamonte
Erika Bracamonte
University of Arizona Medical Center
Tucson | United States
Anthony Chang
Anthony Chang
University of Chicago
United States

J Am Soc Nephrol 2018 Feb 26;29(2):680-693. Epub 2017 Dec 26.

Department of Pathology, Weill Cornell Medicine, New York, New York.

Polyomavirus nephropathy (PVN) is a common viral infection of renal allografts, with biopsy-proven incidence of approximately 5%. A generally accepted morphologic classification of definitive PVN that groups histologic changes, reflects clinical presentation, and facilitates comparative outcome analyses is lacking. Here, we report a morphologic classification scheme for definitive PVN from the Banff Working Group on Polyomavirus Nephropathy, comprising nine transplant centers in the United States and Europe. This study represents the largest systematic analysis of definitive PVN undertaken thus far. In a retrospective fashion, clinical data were collected from 192 patients and correlated with morphologic findings from index biopsies at the time of initial PVN diagnosis. Histologic features were centrally scored according to Banff guidelines, including additional semiquantitative histologic assessment of intrarenal polyomavirus replication/load levels. In-depth statistical analyses, including mixed effects repeated measures models and logistic regression, revealed two independent histologic variables to be most significantly associated with clinical presentation: intrarenal polyomavirus load levels and Banff interstitial fibrosis ci scores. These two statistically determined histologic variables formed the basis for the definition of three PVN classes that correlated strongest with three clinical parameters: presentation at time of index biopsy, serum creatinine levels/renal function over 24 months of follow-up, and graft failure. The PVN classes 1-3 as described here can easily be recognized in routine renal biopsy specimens. We recommend using this morphologic PVN classification scheme for diagnostic communication, especially at the time of index diagnosis, and in scientific studies to improve comparative data analysis.

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Source
http://dx.doi.org/10.1681/ASN.2017050477DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791071PMC

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February 2018
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