Scoring total inflammation is superior to the current Banff inflammation score in predicting outcome and the degree of molecular disturbance in renal allografts

Am J Transplant. 2009 Aug;9(8):1859-67. doi: 10.1111/j.1600-6143.2009.02727.x. Epub 2009 Jun 26.


Emerging molecular analysis can be used as an objective and independent assessment of histopathological scoring systems. We compared the existing Banff i-score to the total inflammation (total i-) score for assessing the molecular phenotype in 129 renal allograft biopsies for cause. The total i-score showed stronger correlations with microarray-based gene sets representing major biological processes during allograft rejection. Receiver operating characteristic curves showed that total-i was superior (areas under the curves 0.85 vs. 0.73 for Banff i-score, p = 0.012) at assessing an abnormal cytotoxic T-cell burden, because it identified molecular disturbances in biopsies with advanced scarring. The total-i score was also a better predictor of graft survival than the Banff i-score and essentially all current diagnostic Banff categories. The exception was antibody-mediated rejection which is able to predict graft loss with greater specificity (96%) but at low sensitivity (38%) due to the fact that it only applies to cases with this diagnosis. The total i-score is able to achieve moderate sensitivities (60-80%) with losses in specificity (60-80%) across the whole population. Thus, the total i-score is superior to the current Banff i-score and most diagnostic Banff categories in predicting outcome and assessing the molecular phenotype of renal allografts.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biopsy
  • Cell Movement
  • Humans
  • Inflammation / diagnosis*
  • Inflammation / pathology*
  • Kaplan-Meier Estimate
  • Kidney / pathology
  • Kidney Transplantation / pathology*
  • Predictive Value of Tests
  • Prognosis
  • Sensitivity and Specificity
  • Severity of Illness Index*
  • T-Lymphocytes, Cytotoxic / pathology
  • Transplantation, Homologous