Banff Classification for Transplant Rejection
Standardizes histopathological classification of allograft rejection to guide immunosuppressive therapy decisions
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a stated value is compared only from the structured summary or a supplied value
- Scoring type
- classification
- Care settings
- Inpatient, Outpatient
When it activates
Scribeable activates a calculator from the encounter. The Banff Classification for Transplant Rejection can activate when the transcript or pasted chart context documents any of these:
- Transplant rejection classification
- Allograft biopsy interpretation
- Kidney transplant rejection grading
- Transplant pathology assessment
- Rejection treatment decision
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: T86.
Inputs the note needs
1 input. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Banff classification category: 1=normal, 2=antibody-mediated changes, 3=borderline changes, 4=T-cell-mediated rejection (IA, IB, IIA, IIB, III), 5=interstitial fibrosis/tubular atrophy, 6=other changes | exam |
Scoring
Category 1: Normal biopsy or nonspecific changes. Category 2: Antibody-mediated changes — active AMR (C4d+, DSA+, microvascular inflammation), chronic active AMR (transplant glomerulopathy, peritubular capillary basement membrane multilayering). Category 3: Borderline changes — suspicious for acute T-cell-mediated rejection. Category 4: T-cell-mediated rejection — IA (tubulitis i2+t2), IB (tubulitis i2+t3), IIA (intimal arteritis v1), IIB (intimal arteritis v2), III (transmural arteritis v3). Category 5: Interstitial fibrosis/tubular atrophy (IF/TA). Category 6: Other (BK nephropathy, recurrent disease, etc.).
Interpretation
Category 1: No treatment needed. Category 2 (AMR): Plasmapheresis, IVIG, anti-CD20 (rituximab), complement inhibitors; chronic AMR has limited treatment options. Category 3 (Borderline): Close monitoring, may treat as mild TCMR if clinical correlation supports. Category 4 IA/IB: Pulse steroids (methylprednisolone). Category 4 IIA/IIB: Pulse steroids + thymoglobulin/ATG. Category 4 III: Aggressive immunosuppression, consider investigational therapy. Category 5: Chronic damage — optimize immunosuppression, manage comorbidities. Mixed rejection (AMR + TCMR) requires combined therapy.
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: Loupy 2017.
- Haas M et al. The Banff 2017 Kidney Meeting Report: revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpointsHaas et al. (Banff 2017) · 2017 · Banff Foundation · Consensus · link last verified 2026-03-28
How Scribeable handles it in the note
When an encounter activates the Banff Classification for Transplant Rejection at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.
The score is computed in code from the resolved inputs, not recalled by the language model. A stated Banff Classification for Transplant Rejection value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.
Classified as a staging or classification system: activated strictly, because a wrong stage on the wrong patient is a documentation hazard.
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