Banff 2022 Liver Group Meeting report: Monitoring long-term allograft health
Christopher Bellamy, Jacqueline G. O’Leary, Oyedele Adeyi, Nahed Baddour, Ibrahim Batal, John C. Bucuvalas, Arnaud Del Bello, Mohamed El Hag, Magda El-Monayeri, Alton B. Farris, Sandy Feng, Maria Isabel Fiel, Sandra E. Fischer, John J. Fung, Krzysztof Grzyb, Maha Guimei, Hironori Haga, John Hart, Annette M. Jackson, Elmar Jaeckel, Nigar Khurram, Stuart J. Knechtle, Drew Lesniak, Josh Levitsky, Geoffrey W. McCaughan, Catriona McKenzie, Claudia Mescoli, Rosa Miquel, Marta I. Minervini, Imad Nasser, Desley Neil, Maura O’Neil, Orit Pappo, Parmjeet Randhawa, Phillip Ruiz, Alberto Sanchez Fueyo, Deborah Schady, Thomas D. Schiano, Mylène Sebagh, Maxwell L. Smith, Heather L. Stevenson, Timuçin Taner, Richard Taubert, Swan N. Thung, Pavel Trunečka, Hanlin L. Wang, Michelle A. Wood, Funda Yılmaz, Yoh Zen, Adriana Zeevi, Anthony J. Demetris
Abstract
The Banff Working Group on Liver Allograft Pathology met in September 2022. Participants included hepatologists, surgeons, pathologists, immunologists, and histocompatibility specialists. Presentations and discussions focused on the evaluation of long-term allograft health, including noninvasive and tissue monitoring, immunosuppression optimization, and long-term structural changes. Potential revision of the rejection classification scheme to better accommodate and communicate late T cell-mediated rejection patterns and related structural changes, such as nodular regenerative hyperplasia, were discussed. Improved stratification of long-term maintenance immunosuppression to match the heterogeneity of patient settings will be central to improving long-term patient survival. Such personalized therapeutics are in turn contingent on a better understanding and monitoring of allograft status within a rational decision-making approach, likely to be facilitated in implementation with emerging decision-support tools. Proposed revisions to rejection classification emerging from the meeting include the incorporation of interface hepatitis and fibrosis staging. These will be opened to online testing, modified accordingly, and subject to consensus discussion leading up to the next Banff conference.