1. Looking Back: Reflections on Banff 1991 From Banff 2003 Douglas R. Wilson, M.D.

2. Slide 2 Statement in 1991: Why Banff? Searching for the muse! The Muses were nine goddesses of the arts and sciences in Greek mythology.The Muses were nine goddesses of the arts and sciences in Greek mythology. The Muses lived on Mount Olympus with their leader, the god Apollo. Like him the Muses remained young and beautiful forever.The Muses lived on Mount Olympus with their leader, the god Apollo. Like him the Muses remained young and beautiful forever. They could see into the future, which few other gods could do. They also had the ability to banish all grief and sorrow. The muses had pleasing melodic voices and often sang as a chorus.They could see into the future, which few other gods could do. They also had the ability to banish all grief and sorrow. The muses had pleasing melodic voices and often sang as a chorus. Early Greek writers and artists called on the muses for inspiration before beginning to work.Early Greek writers and artists called on the muses for inspiration before beginning to work.

3. Slide 3 The Nine Muses Any or all of the muses could be asked for assistance even though each governed a specific art or science: 1.Calliope: Muse of epic poetry 2.Erato: Muse of love poetry 3.Euterpe: Muse of lyric poetry 4.Melpomene: Muse of tragedy 5.Thalia: Muse of comedy 6.Clio: Muse of history 7.Urania: Muse of astronomy 8.Polyhymnia: Muse of sacred song 9.Terpsichore: Muse of dance

4. We call on CLIO: The MUSE of HISTORY And THALIA: The MUSE of COMEDY Out of Disaster…and…From the Heart came… BANFF !!

5. 1989 - International Society of Nephrology launched the ISN Commission on Acute Renal Failure, chaired by Kim Solez, with a focus on disaster relief, in response to the disorganized international approach to the earthquake in Armenia 1989 - International Society of Nephrology launched the ISN Commission on Acute Renal Failure, chaired by Kim Solez, with a focus on disaster relief, in response to the disorganized international approach to the earthquake in Armenia 1990 – Published work on standardization of nomenclature for the diagnosis of heart and lung transplant rejection. 1990 – Published work on standardization of nomenclature for the diagnosis of heart and lung transplant rejection.

6. 1991 - August 2-4 First Banff meeting organized by ISN Commission to include a meeting of the Disaster Relief Task Force…and… 1991 - August 2-4 First Banff meeting organized by ISN Commission to include a meeting of the Disaster Relief Task Force…and… “Workshop on International Standardization of the Nomenclature and Criteria for the Histologic Diagnosis of Kidney Transplant Rejection”… “Workshop on International Standardization of the Nomenclature and Criteria for the Histologic Diagnosis of Kidney Transplant Rejection”… It’s no wonder that it came to be called the Banff schema !!

7. Slide 7 Notable Features of first Banff meeting included : Good advance work (Croker,Olsen, Racusen, Solez) Good advance work (Croker,Olsen, Racusen, Solez) Small size - about 20 participants Small size - about 20 participants Mix of pathologists and transplant clinicians (7-8 of each, and largely in teams from the same center) Mix of pathologists and transplant clinicians (7-8 of each, and largely in teams from the same center) International involvement – Canada (2), USA (3), Denmark, Finland International involvement – Canada (2), USA (3), Denmark, Finland Fine arts accompaniment – recitals and Cosi fan Tutte - the Muses of Poetry, Dance and Song Fine arts accompaniment – recitals and Cosi fan Tutte - the Muses of Poetry, Dance and Song

8. Slide 8 The way we were! Movies from 1991 courtesy of Phil and Ginny Halloran! The way we were! Movies from 1991 courtesy of Phil and Ginny Halloran!

9. Slide 9 Video Clip from Banff 1991

10. Slide 10 LOTS OF FOLLOW-UP WORK by phone, fax, meetings and correspondence to: greatly widen the circle of those involved greatly widen the circle of those involved circulate sets of slides for panel assessment circulate sets of slides for panel assessment publication of Banff schema in high quality international journal (Kidney International 44: 411-422,1993) publication of Banff schema in high quality international journal (Kidney International 44: 411-422,1993) with inclusive authorship – USA (10 centers), Canada (3), UK (1), Denmark (1), Finland (1), Switzerland (1), and Japan (2) with inclusive authorship – USA (10 centers), Canada (3), UK (1), Denmark (1), Finland (1), Switzerland (1), and Japan (2)

11. Slide 11 Maintain Momentum A work-in-progress for 12 years Bi-Annual meetings – Bi-Annual meetings – 1993, 1995, 1997, 1999, 2001 at Banff Springs Hotel and Rimrock Resort Active involvement of liver transplant pathologists and clinicians Active involvement of liver transplant pathologists and clinicians Widespread use of the classification in world wide sites and in clinical trials of immunosuppressive regimens Widespread use of the classification in world wide sites and in clinical trials of immunosuppressive regimens

12. Ability to achieve agreement on changes based on other schema – 1997 – Collaborative Clinical Trials in Transplantation (CCTT) Ability to achieve agreement on changes based on other schema – 1997 – Collaborative Clinical Trials in Transplantation (CCTT) Regular, significant, and inclusive publications Regular, significant, and inclusive publications Kidney International 55: 713-723,1999 (27 centers) and Am. J Transplantation 3:1-7,2003 (24 centres)

13. Much has been accomplished, Much has been learned… …or…What does it take to get 41 pathologists and clinicians to collaborate ??…over a long time ! Lessons Learned – 6 Success Factors ‘Common cause’ that has obvious importance and practical ‘value-added’ ‘Common cause’ that has obvious importance and practical ‘value-added’ A ‘loose – tight’ organization – inclusive, flexible, but goal-driven. Function is more important than structure! A ‘loose – tight’ organization – inclusive, flexible, but goal-driven. Function is more important than structure!

14. Collaboration of pathologists and clinicians is critical (or.. It is easier for pathologists to agree if there are simple clinicians involved with them Collaboration of pathologists and clinicians is critical (or.. It is easier for pathologists to agree if there are simple clinicians involved with them Committed ‘champions’ willing to push the process of collaboration over extended time period Committed ‘champions’ willing to push the process of collaboration over extended time period Willingness of all to share ‘the credit’ Willingness of all to share ‘the credit’ Pleasure and satisfaction of working and having fun with international colleagues Pleasure and satisfaction of working and having fun with international colleagues Collaboration of pathologists and clinicians is critical (or.. It is easier for pathologists to agree if there are simple clinicians involved with them Collaboration of pathologists and clinicians is critical (or.. It is easier for pathologists to agree if there are simple clinicians involved with them Committed ‘champions’ willing to push the process of collaboration over extended time period Committed ‘champions’ willing to push the process of collaboration over extended time period Willingness of all to share ‘the credit’ Willingness of all to share ‘the credit’ Pleasure and satisfaction of working and having fun with international colleagues Pleasure and satisfaction of working and having fun with international colleagues

15. Here is a Toast to the melodic voices of the chorus of Muses !! Here is a Toast to the melodic voices of the chorus of Muses !!