1. Summaries by Session Chairs of Banff 2003: C4d scoring/Ab mediated reject. - Bob Colvin GeneAnalysis/Microarrays/Tubulitis/Tolerance - Lorraine Racusen Liver - Jake Demetris Heart - Rene Rodriguez/Kim Solez Monocytes/Macrophages - Andy Rees Schema Updates and the Future - Kim Solez

2. Case II Summary PTC Inflammatory Changes 1 week: g1,i2,t1,v0,cg0,mm0,ci0,ct0,cv0,ah0; g1 with thrombotic microangiopathy, ATN, moderate PTC inflammation (‘ptc2’) 1 month: g0,i2,t1,v0,cg0,mm0,ci1,ct1,cv0,ah0; mild PTC inflammation (‘ptc1’) 2.5 months: g0,i0,t1,v0,cg0,mm0,ci1,ct1,cv0,ah0; severe PTC inflammation (‘ptc3’) 4 months: g0,i2,t1,v0,cg0,mm0,ci2,ct2,cv0,ah0; moderate PTC inflammation (‘ptc2’) 7 months: g0,i1,t1,v0,cg0,mm0,ci1,ct1,cv0,ah0; moderate PTC inflammation (‘ptc2’) Proposal: Banff type scoring of PTC inflammation, with objective criteria

3. The Point of Banff Directing the eye / mind of the pathologist to the relevant areas of the Bx, which for acute rejection are: glomerulitis – g score interstitial inflammation – i score lymphocytic tubulitis – t score intimal arteritis – v score By the same principle, in possible AbAR, a further relevant area is: peritubular capillaritis - ? ptc score

4. Proposal – Banff ptc score ptc 0 – no significant cortical peritubular inflammatory changes ptc 1 – cortical peritubular capillary with 3 to 4 luminal inflammatory cells* ptc 2 – cortical peritubular capillary with 5 to 10 luminal inflammatory cells* ptc 3 – cortical peritubular capillary with >10 luminal inflammatory cells* * Asterisk given if cells are mononuclear only. Numbers refer to highest number seen of all types of inflammatory cells.

5. Proposal – Banff ptc score Notes: Inflammatory cells include PMNLs, lymphocytes, and monocyte/macrophages. Avoid scoring in just subcapsular cortex, or just around areas of necrosis or infarction, or as part of pyelo. PTCs are characteristically dilated. Inflammmatory cell aggregates are often diffuse, indicate extent when not diffuse. Scoring should be done on PAS or silver stain. Ideally, those cells within PTC should be excluded from the i score.

6. Proposal – Nephrectomy Study Look at circulating anti Class I and Class II donor reactive antibody by solid phase or flow assay* and V3 lesions of patients with nephrectomy for refectory acute rejection or chronic allograft nephropathy where immunosuppression has been withdrawn or tapered before nephrectomy. A study looking at the “natural unmodified rejection” that occurs under these circumstances, asking the question of whether transmural arteritis and fibrinoid change are inexorably linked or are separable and of different significance. Is transmural arteritis per se a feature of antibody mediated rejection, or is fibrinoid change the arterial lesion linked with this entity. If possible, a portion of nephrectomy should be frozen for immuno studies in same fashion as is done for percutaneous biopsies. Markers for C4d, immunoglobulins, and CD68, CD20, CD79a, CD138, and CD3 should be used. * pre and post nephrectomy, at least three weeks post

7. Proposal – Electronic Proficiency Testing Using Solez/Racusen 25 workshop cases and Johnathan Epstein’s prostate websites as models.

8. 2005: Edmonton, Canada 2007: Edinburgh, Scotland 2009: Banff, Canada See you there! Future Banff Meetings: 2005: Edmonton, Canada 2007: Edinburgh, Scotland 2009: Banff, Canada See you there!