Banff foundation and future of transplantation

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Information about Banff foundation and future of transplantation
Health & Medicine

Published on March 11, 2014

Author: ksolez



Dr. Kim Solez presents The Banff Foundation for Allograft Pathology and the Future of Transplantation for the ATI Fellows Lecture Series March 11, 2014 at the University of Alberta in Edmonton, Canada.

Kim Solez, MD

 Images from 1991

 . The Banff Schema was first developed at a meeting of pathologists, clinicians and surgeons in Banff, Alberta, Canada, August 2-4, 1991 and has become the worldwide standard for the interpretation of transplant biopsies.

A moderated self-organizing group to define and standardize organ allograft biopsy interpretation Aim is to promote international uniformity in reporting allograft pathology, which is necessary for research, clinical trials, and standardized patient management International and inter-disciplinary process with meetings every 2 years Mini-review “The Banff Classification Revisited” (Solez, K. and Racusen, L.C.) appeared in Kidney International last year

 1991 First Conference  1993 First Kidney International publication  1995 Integration with CADI  1997 Integration with CCTT classification  1999 Second KI paper. Clinical practice guidelines. Implantation biopsies, microwave  2001 Classification of antibody-mediated rejection Regulatory agencies participating  2003 Genomics focus, ptc cell accumulation scoring  2005 Gene chip analysis. Elimination of CAN, identification of chronic antibody-mediated rejection  2007 First meeting far from a town called “Banff” – La Coruna, Spain  2009 Working groups. Meeting in Banff, Alberta, Canada for last time  2011 Planning for Banff Foundation begun.  2013 Establishment of Banff Foundation for Allograft Pathology supported by Roche Organ Transplantation Research Foundation (ROTRF).

 Given changed regulations and climate surrounding pharma support we can never again hold the Banff meeting in a resort location. Future meetings will have to be in regular business destination cities. We are very grateful for the extraordinary hard work undertaken by the Brazil organizers this year, a herculean effort!  Vancouver for Banff 2015 in cooperation with the Canadian Society of Transplantation.  For 2017 and 2019 Barcelona and Pittsburgh will work if the necessary infrastructure and background stability can be found, otherwise Edmonton could be considered. The 2001 Banff meeting in Edmonton was quite successful, uncomplicated.  The many accomplishments of the Banff process can be used to establish useful partnerships with cities, as we did with Aberdeen in 2003. Many cities offer financial incentives to groups planning meetings.

86% Kidney clinical 6% Liver clinical 5% Kidney experimental 1% Liver experimental Most articles are in high quality journals with impact factor of 3.2 or higher, one third have impact factors of 6-9.

 The Banff meeting reports and main meeting papers have been cited over 5,000 times in the medical literature. The 1999 paper The Banff 97 Working Classification of Renal Allograft Pathology Kidney International 55(2):713-23, 1999 by Racusen, Solez, and Colvin et al. is a citation classic in the field having been cited 2,478 times.

Classification begun at 1991 Banff meeting has become the worldwide standard, and the consensus process has now extended to all solid organs. Future meetings are planned every two years through 2019. Standardization principles now being extended from biopsy reporting to tissue typing, imaging, all the other elements in transplant care. Classification used in clinical trials, and by the FDA, mandatory evaluation for drug approvals.

Isolated v-lesion Working Group IHC Quality Assurance Working Group Glomerular Lesion Working Group Polyoma Virus Nephropathy Working Group Fibrosis Scoring Working Group Data-driven & Validated Refinement of the Banff Guidelines Banff Working Groups: Addressing unmet needs in a data-driven, evidence based approach Sis et al. 2009 Banff Meeting Report, Am J Transplant. 2010 Mar;10(3):464-71 C4d-Negative ABMR Working Group

Isolated V lesion – Banu Sis and Ed Kraus Fibrosis scoring – Robert Colvin Polyoma virus staging – Volker Nickeleit Glomerular lesion scoring – Mark Haas Molecular pathology – Phil Halloran Quality assurance IHC – Michael Mengel C4d neg. Ab-Mediated Rejection – Banu Sis History&Impact of Banff Process – Kim Solez

Includes analysis of physician facilitation of consensus discussions, seen most recently in Bob Colvin’s C4d discussions and in Michael Mengel’s organization of Banff Working Groups. Also includes analysis of future trends and developments.

 Before 2013 we have had none beyond Drs. Racusen and Solez.  Formed Swiss foundation legal entity in 2013, the Banff Foundation for Allograft Pathology.

To lead development and dissemination of the international Banff Classification of Allograft Pathology and to facilitate multidisciplinary, collaborative research to enhance its scientific basis and clinical utility to improve the care of transplant patients.

 Facilitation of knowledge generation and translation in transplantation pathology with the ultimate aim to improve patient outcome  Maintaining the Banff spirit of a multinational, multidisciplinary consensus group  Fundraising  Guidance and financial support for Working Group activities  Guidance and financial support for Banff meetings activities

 Responsible for annual reports of the Foundation and adherence to Swiss law  Fiduciary responsibility for foundation funds  Final responsibility for selection and content of Banff meetings  Support and guide Working Group activities  External representation of the Banff process: fundraising, policy papers, set up, content, and maintenance of a Banff website  Bidirectional communication to membership of the Banff community  Composition: The BOD consists of 6-9 members, including the Chair. Members are selected by majority vote of the BOD and serve for a 3 year term, renewable once. Terms are staggered (3 selected each year). The Chair and Secretary/Treasurer are selected by a majority vote of the BOD and serve for a 3 year term, renewable once. Vacancies filled by majority vote of BOD.

 Secretary/Treasurer Responsible for day-to-day business/activities of the Banff Foundation for Allograft Pathology and annual reporting Is a member of the board and regularly reports to the other board members  Prepares annual budget and projections  Monitors expenses Works closely with the administrative team  Flow and handling of funds through the Foundation:  A foundation should generate funding from whatever sources over its lifetime, to fulfil its purpose; which in this case would be to run Banff meetings and to foster advances in organ transplantation  Therefore the recommendation is to run any money e.g. from a pharmaceutical company into the Swiss Foundation, which then will at the Board of Trustees instruction transferred to a trusted organising committee, e.g. a University or Society account from local Banff meeting organizers , or Banff working group leaders for supporting their activities

 Organization of meetings together with local organizers  Organization of cross-organ plenary sessions  Program finalization according to input from Organ Steering committees  Selection of speakers and moderators  Support and coordination of preparation of meeting reports  Terms of references: Appointed by the BOD terms of membership four years (i.e. two meetings), renewable through majority vote of the board

 Should engage pathologists and clinicians as well as representative from major geographic regions (e.g. North America, South America, Europe, Asia, Africa, Australia)  Fund raising for the meetings and consensus work should also be scope for the organ steering committee members  Organization of organ specific sessions: selection of topics and speakers  Preparation of organ specific meeting reports  Terms of reference: Leadership appointed by the board of directors for four years (i.e. two meetings), renewable through majority vote of the board Otherwise self-organized

Future concepts of where technology is taking us are incorporated into long term planning of Banff Process.  Moore’s Law&Eroom’s Law , the technological Singularity and exponential change, exponential decline in # new drugs per billion dollars R&D expenditure. We should proactively address the challenges of the future, not be passive victims of events, keep ahead of the game.

The Banff Foundation for Allograft Pathology Must Remain Youthful and Relevant for the Future – Must Adapt, Plan for Changes  As the field changes and stem-cell-grown organs replace transplantation, the organization must change with it  Transplantation may be loosing its luster but luster of the Banff Foundation for Allograft Pathology can remain strong. We need to foster sense of community – consider membership fees.  Need more young people&women. Enhanced cooperation with other organizations, AST, TTS, Eurotransplant.  As an exercise in alternative realities, at Gala Dinner I asked participants to consider the very different life of David Crippen, my counterpart in critical care medicine. We need to consider changes that large!

The spectacular dynamics influencing the pace of stem generation of organs replacing transplantation in the future.  There were YouTube videos (now removed) suggesting that stem cell generation of complex organs in humans would be routine by 2020.  The dramatic slowdown of new drug approvals (Eroom’s Law) by the FDA suggests that the FDA is ripe for disruptive innovation.  However stem cell therapies may be the last area the FDA will relax regulation in, as unproven bogus stem cell therapies are causing widespread suffering and protection of the general public is needed.  The role of the pathologist/laboratory physician will increase/expand in the coming decades and they will begin practicing standing up!

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