Table 2.

Interpretation of the Banff Classification

Banff code	Descriptive term	Pathophysiology	Interpretation	Treatment
i	Interstitial inflammation	Infiltration of interstitium by mononuclear cells	Linked with cellular rejection but also viral infection	Intensification of immunosuppression –often pulsed intravenous steroids
t	Tubulitis	Infiltration of renal tubules by mononuclear cells	Linked with cellular rejection but also viral infection	Intensification of immunosuppression –often pulsed intravenous steroids
g	Glomerulitis	Margination of inflammatory leukocytes in the glomerular capillary loops	Marker of humeral rejection	Intensification of immunosuppression if not too much chronic damage
v	Arterial inflammation	Inflammation of arterial wall with infiltration of mononuclear cells	Marker of either severe cellular rejection or humeral rejection	Intensification of immunosuppression ifnot too much chronic damage
ptc	Peritubular capillaritis	Margination of inflammatory cells in the peritubular capillaries	Marker of humeral rejection	Intensification of immunosuppression if not too much chronic damage
ci	Interstitial Fibrosis	Interstitial structure replaced by fibrosis	Marker of chronic damage	Poor prognostic sign – may prompt reduction in CNI
ct	Tubular atrophy	Interstitial tubules involuted	Marker of chronic damage	Poor prognostic sign – may prompt reduction in CNI
cg	Transplant glomerulopathy	Interposition of mesangium and thickening of GBM	Associated with proteinuria and development of DSAs – End lesion of CAMR	Poor prognosis – no known treatment but intensification of immunosuppression often practiced
mm	Mesangial matrix expansion	Increase of thickness of mesangial matrix	Marker of microvascular damage to glomerulus	Usually interpreted in association with other findings
cv	Arterial fibrointimal thickening	Expansion of intima between endothelium and media	Marker of chronic damage – non-specific	Poor prognostic sign – vascular protective measures
ah	Arteriolar hyalinosis	Nodular deposition of hyaline	CNI toxicity but non-specific (e.g. HT, DM, lipids)	Reduction or withdrawal of CNI