Banff Rejection Classification (Renal Transplant)
Classifies renal transplant rejection using Banff criteria from biopsy findings. Guides pulse steroids, antibody-mediated therapy, and transplant team management.
Score interpretation
→ Optimise immunosuppression adherence; ensure therapeutic levels (tacrolimus trough 5-8); repeat biopsy in 3-6 months if borderline; nephrology follow-up
→ Pulse IV methylprednisolone 500mg x3 days; review tacrolimus levels; check adherence; repeat creatinine daily; transplant nephrology urgently; protocol biopsy at 3 months
→ AMR: IVIG 2g/kg + rituximab +/- plasmapheresis; severe TCMR: ATG (rabbit anti-thymocyte globulin); transplant team emergency; graft loss risk; consider belatacept switch; monitor for CMV and BK virus reactivation
Interpretation bands for the Banff Rejection Grade. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Ganciclovir · Antiviral — CMV Treatment (IV) / Retinitis / Transplant
- Rituximab (Nephrology) · ANCA Vasculitis / Nephrotic Syndrome
- Cyclophosphamide (Nephrology) · ANCA Vasculitis / Lupus Nephritis
- Methylprednisolone IV Pulse (Nephrology) · Glomerulonephritis / Vasculitis
- Vancomycin (Renal Dosing) · Antibiotic Dosing in CKD
- Gentamicin (Renal Dosing/TDM) · Antibiotic Dosing in CKD
- Hyperkalaemia Management · UK Kidney Association Guidelines 2020; NICE CKD Guidelines
- Rhabdomyolysis · Renal Association 2018; UpToDate 2024
- Hypocalcaemia (Adult) · Society for Endocrinology
- SIADH (Endocrine Perspective) · European Hyponatraemia Guidelines 2014
- Hepatorenal Syndrome · EASL 2018; ICA 2015
- Acute Kidney Injury (AKI) · KDIGO 2012 / NICE AKI 2019
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.