CORRELATION BETWEEN BANFF CRITERIA AND OUTCOME AT 12 MONTHS FOLLOWING ACUTE REJECTION IN MULTICENTER RANDOMIZED TRIAL
Linda Weaver Moore, Robert S. Gaston · Transplantation · 1998
222 This report describes the correlation between severity of acute rejection as determined by Banff criteria and 12 month outcome following treatment with Thymoglobulin or Atgam. Methods: The study design required a moderate (Grade II) or severe (Grade III) rejection for enrollment and allowed mild (Grade I) steroid resistant rejection. A total of 162 cases of rejection were stratified based on Banff grade for severity and treated: 19 Grade I, 115 Grade II, and 28 Grade III acute rejections. Results: By 12 months following the initial rejection diagnosis, recurrent rejection was similar across each rejection severity grade and occurred in 33 patients: 5 Grade I (26%), 22 Grade II(19%), and 6 Grade III (21%). However, there were more recurrent rejections in the ATG treated patients (25%) vs TMG treated patients (15%), p = 0.05. Graft survival was not significantly different at 12 months for the TMG therapy group compared to the ATG therapy group (intent-to-treat). However, when 12 month graft survival was analyzed according to rejection severity, a significantly worse outcome was experienced by those grafts originally determined to be Grade III rejection independent of treatment modality.TableConclusion: We find a correlation between Banff grade of acute rejection and outcome at 12 months following therapy. Grade III acute rejection outcomes are uniformly poor while Grades I and II are approximately the same (83%). Separations between the outcomes for these three grades of rejection severity appear to be affected by antirejection therapy, i.e. TMG vs ATG.