Banff fibrosis study: multicenter visual assessment and computerized analysis of interstitial fibrosis in kidney biopsies

Am J Transplant. 2014 Apr;14(4):897-907. doi: 10.1111/ajt.12641. Epub 2014 Feb 20.


Increasing interstitial fibrosis (IF) in native and kidney transplant biopsies is associated with functional decline and serves as a clinical trial end point. A Banff 2009 Conference survey revealed a range in IF assessment practices. Observers from multiple centers were asked to assess 30 renal biopsies with a range of IF and quantitate IF using two approaches on trichrome, Periodic acid-Schiff (PAS) and computer-assisted quantification of collagen III immunohistochemistry (C-IHC) slides, as well as assessing percent of cortical tubular atrophy% (TA%) and Banff total cortical inflammation score (ti-score). C-IHC using whole slide scans was performed. C-IHC assessment showed a higher correlation with organ function (r = -0.48) than did visual assessments (r = -0.32--0.42); computerized and visual C-IHC assessment also correlated (r = 0.64-0.66). Visual assessment of trichrome and C-IHC showed better correlations with organ function and C-IHC, than PAS, TA% and ti-score. However, visual assessment of IF, independent of approach, was variable among observers, and differences in correlations with organ function were not statistically significant among C-IHC image analysis and visual assessment methods. C-IHC image analysis correlated among three centers (r > 0.90, p < 0.0001, between all centers). Given the difficulty of visual IF assessment standardization, C-IHC image could potentially accomplish standardized IF assessment in multicenter settings.

Keywords: Allograft monitoring; Banff schema; chronic graft deterioration; collagen; end points; fibrosis; graft function; image analysis; kidney; pathologist; pathology of renal transplantation.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biopsy
  • Collagen Type III / metabolism*
  • Fibrosis / classification*
  • Fibrosis / metabolism
  • Fibrosis / pathology*
  • Follow-Up Studies
  • Humans
  • Image Processing, Computer-Assisted*
  • Immunoenzyme Techniques
  • Kidney Tubules / metabolism
  • Kidney Tubules / pathology*
  • Observer Variation
  • Prognosis


  • Collagen Type III