Abstract: TH-OR105
Use of Banff Activity and Chronicity Indices to Predict Kidney Allograft Outcomes: An External Validation Study of 11,442 Cases
Session Information
- The Next Frontier in Kidney Transplantation: Omics, Gene Editing, and Precision Medicine
October 22, 2026 | Location: Mile High Ballroom 4A, Convention Center
Abstract Time: 05:20 PM - 05:30 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Ijaz, Aleena, Arkana Laboratories, Little Rock, Arkansas, United States
- Storey, Aaron J., Arkana Laboratories, Little Rock, Arkansas, United States
- Larsen, Christopher Patrick, Arkana Laboratories, Little Rock, Arkansas, United States
- Caza, Tiffany, Arkana Laboratories, Little Rock, Arkansas, United States
Background
The Banff classification system is widely used for diagnosis of allograft rejection, but individual lesion scores are not predictive of prognosis. Banff activity and chronicity indices combine active and chronic lesion scores and have demonstrated correlation with prognosis in two previously reported cohorts. Here, we perform the largest external validation study to date in a retrospective cohort of 11,442 biopsies.
Methods
Data from 60,186 transplant biopsies was linked to the Scientific Registry of Transplant Recipients for outcome data. Biopsies meeting Banff adequacy criteria with ≥5 years' follow-up were included. We calculated the Banff activity index [=i + t + v + g + ptc + C4d (0-2)] and chronicity index [=ci + ct + cv + (cg x 2)] for each biopsy. Kaplan-Meier survival analysis examined correlation of index scores with allograft survival at five years.
Results
Patients had a mean age of 47.8 ± 17.3 years, were 59.9% male, and 70.2% received deceased donor transplants. The most common diagnoses included rejection (35.8%), acute tubular injury (24.4%), and polyomavirus nephritis (17.1%). Graft failure occurred in 30.6% at five years. Mean Banff activity and chronicity scores were 2.3 ± 2.9 and 3.8 ± 3.1, respectively.
Kaplan-Meier analysis demonstrated that both indices strongly predicted graft failure (p < 0.0001, log-rank test). A dose-response relationship was observed, with higher scores corresponding to progressively worse survival. Transplants with scores of 0-4 maintained ≥70% survival at 5 years, while scores of 11-14 fell to 25-50%. Activity scores correlated with earlier and steeper graft loss, while chronicity scores showed a more gradual decline (both p<0.0001, Figure 1).
Conclusion
These findings support inclusion of Banff Activity and Chronicity indices to transplant reporting to inform prognosis.