Banff Conference Research Articles

Update kidney allograft pathology : Abetter depiction of microvascular inflammation

The Banff Foundation produces recommendations for classifying various lesions in renal allografts. Experts gather to update the classification every other year based on new scientific and clinical evidence. This article presents the most important changes incorporated into the new recommendations after the last Banff conference. The author of this article personally took part in the Banff conference and the subsequent survey, reported on the activities of aBanff working group (peritubular capillaritis) on-site, and contributed to drafting the recently published meeting report. Lesions of antibody-mediated kidney allograft rejection (AMR), especially microvascular inflammation, have been part of the diagnostic algorithm for over 20years. Experts advocated for asimplified AMR algorithm and mindful inclusion of molecular pathological data in the clinicopathological reflection regarding therapeutic decision. Anew, more descriptive diagnostic entity-microvascular inflammation, C4d negative and DSA negative-has been introduced into the AMR category to acknowledge this histological constellation and motivate research into this pathophysiologically and immunologically probably different phenotype. The Banff classification provides astructure for diagnosing kidney transplant pathology. Regular updates serve to adapt to ever-growing knowledge about alloimmunity. Particular challenges are capturing the complexity of various immunological scenarios and ensuring an understandable representation of these in apathology report.

Banff 2022 Liver Group Meeting report: Monitoring long-term allograft health

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.

Banff consensus recommendations for steatosis assessment in donor livers.

Background and AimsNo consensus criteria or approaches exist regarding assessment of steatosis in the setting of human donor liver suitability for transplantation. The Banff Working Group on Liver Allograft Pathology undertook a study to determine the consistency with which steatosis is assessed and reported in frozen sections of potential donor livers.Approach and ResultsA panel of 59 pathologists from 16 countries completed a questionnaire covering criteria used to assess steatosis in donor liver biopsies, including droplet size and magnification used; subsequently, steatosis severity was assessed in 18 whole slide images of donor liver frozen sections (n = 59). Survey results (from 56/59) indicated a wide variation in definitions and approaches used to assess and report steatosis. Whole slide image assessment led to a broad range in the scores. Findings were discussed at a workshop held at the 15th Banff Conference on Allograft Pathology, September 2019. The aims of discussions were to (i) establish consensus criteria for defining “large droplet fat” (LDF) that predisposes to increased risk of initial poor graft function and (ii) develop an algorithmic approach to determine fat droplet size and the percentage of hepatocytes involved. LDF was defined as typically a single fat droplet that expands the involved hepatocyte and is larger than adjacent nonsteatotic hepatocytes. Estimating severity of steatosis involves (i) low magnification estimate of the approximate surface area of the biopsy occupied by fat, (ii) higher magnification determination of the percentage of hepatocytes within the fatty area with LDF, and (iii) final score calculation.ConclusionsThe proposed guidelines herein are intended to improve standardization in steatosis assessment of donor liver biopsies. The calculated percent LDF should be provided to the surgeon.

American Journal of Transplantation: Volume 21, Number 7, July 2021

On the cover: 2021 marks the 30th anniversary Banff Conferences on Allograft Pathology, which has provided worldwide standards for the interpretation of allograft biopsies. One momentous milestone, the first detailed classification of antibody-mediated rejection in kidney transplantation, was achieved 10 years later in 2001 as a result of “lively and in-depth discussions.”* Over the ensuing 20 years, this classification has undergone multiple and significant iterations driven by emerging data. Callemeyn and colleagues (page 2413), utilizing a decade-long cohort of both protocol and clinically indicated allograft biopsies, crystallize the ramifications of this “punctuated disequilibrium.” They quantify the impact of the changes in diagnostic classification of antibody-mediated rejection from Banff 2013 to Banff 2017 and compare allograft survival, identifying inferior prognostic accuracy for the 2017 classification scheme. This study raises many provocative questions, perhaps the most important of which is whether the purpose of Banff classification is diagnosis or risk stratification, as discussed by Mengel and Mannon (page 2321). *Racusen LC, Colvin RB, Solez K, et al. Antibody-mediated rejection criteria – an addition to the Banff ’97 classification of renal allograft rejection. Am J Transplant. 2003;3(6):708–714. Cover design by Megan Llewellyn, Duke University Section of Surgical Disciplines.

Patients included at CAPO/IPOS World Congress of Psycho-Oncology 2019. Reflections from the invited advocates

Patients included at CAPO/IPOS World Congress of Psycho-Oncology 2019. Reflections from the invited advocates

Significance of revised criteria for chronic active T cell-mediated rejection in the 2017 Banff classification: Surveillance by 1-year protocol biopsies for kidney transplantation.

Diagnostic criteria for chronic active T cell-mediated rejection (CA-TCMR) were revised in the Banff 2017 consensus, but it is unknown whether the new criteria predict graft prognosis of kidney transplantation. We enrolled 406 kidney allograft recipients who underwent a 1-year protocol biopsy (PB) and investigated the diagnostic significance of Banff 2017. Interobserver reproducibility of the 3 diagnosticians showed a substantial agreement rate of 0.68 in Fleiss's kappa coefficient. Thirty-three patients (8%) were classified as CA-TCMR according to Banff 2017, and 6 were previously diagnosed as normal, 12 as acute TCMR, 10 with borderline changes, and 5 as CA-TCMR according to Banff 2015 criteria. Determinant factors of CA-TCMR were cyclosporine use (vs tacrolimus), previous acute rejection, and BK polyomavirus-associated nephropathy. In survival analysis, the new diagnosis of CA-TCMR predicted a composite graft endpoint defined as doubling serum creatinine or death-censored graft loss (log-rank test, P<.001). In multivariate analysis, CA-TCMR was associated with the second highest risk of the composite endpoint (hazard ratio: 5.42; 95% confidence interval, 2.02-14.61; P<.001 vs normal) behind antibody-mediated rejection. In conclusion, diagnosis of CA-TCMR in Banff 2017 may facilitate detecting an unfavorable prognosis of kidney allograft recipients who undergo a 1-year PB.

The XVth Banff Conference on Allograft Pathology the Banff Workshop Heart Report: Improving the diagnostic yield from endomyocardial biopsies and Quilty effect revisited.

The XVth Banff Conference on Allograft Pathology meeting was held on September 23-27, 2019, in Pittsburgh, Pennsylvania, USA. During this meeting, two main topics in cardiac transplant pathology were addressed: (a) Improvement of endomyocardial biopsy (EMB) accuracy for the diagnosis of rejection and other significant injury patterns, and (b) the orphaned lesion known as Quilty effect or nodular endocardial infiltrates. Molecular technologies have evolved in recent years, deciphering pathophysiology of cardiac rejection. Diagnostically, it is time to integrate the histopathology of EMBs and molecular data. The goal is to incorporate molecular pathology, performed on the same paraffin block as a companion test for histopathology, to yield more accurate and objective EMB interpretation. Application of digital image analysis from hematoxylin and eosin (H&E) stain to multiplex labeling is another means of extracting additional information from EMBs. New concepts have emerged exploring the multifaceted significance of myocardial injury, minimal rejection patterns supported by molecular profiles, and lesions of arteriolitis/vasculitis in the setting of T cell-mediated rejection (TCMR) and antibody-mediated rejection (AMR). The orphaned lesion known as Quilty effect or nodular endocardial infiltrates. A state-of-the-art session with historical aspects and current dilemmas was reviewed, and possible pathogenesis proposed, based on advances in immunology to explain conflicting data. The Quilty effect will be the subject of a multicenter project to explore whether it functions as a tertiary lymphoid organ.

Banff 2019 Meeting Report: Molecular diagnostics in solid organ transplantation-Consensus for the Banff Human Organ Transplant (B-HOT) gene panel and open source multicenter validation.

This meeting report from the XV Banff conference describes the creation of a multiorgan transplant gene panel by the Banff Molecular Diagnostics Working Group (MDWG). This Banff Human Organ Transplant (B‐HOT) panel is the culmination of previous work by the MDWG to identify a broadly useful gene panel based on whole transcriptome technology. A data‐driven process distilled a gene list from peer‐reviewed comprehensive microarray studies that discovered and validated their use in kidney, liver, heart, and lung transplant biopsies. These were supplemented by genes that define relevant cellular pathways and cell types plus 12 reference genes used for normalization. The 770 gene B‐HOT panel includes the most pertinent genes related to rejection, tolerance, viral infections, and innate and adaptive immune responses. This commercially available panel uses the NanoString platform, which can quantitate transcripts from formalin‐fixed paraffin‐embedded samples. The B‐HOT panel will facilitate multicenter collaborative clinical research using archival samples and permit the development of an open source large database of standardized analyses, thereby expediting clinical validation studies. The MDWG believes that a pathogenesis and pathway based molecular approach will be valuable for investigators and promote therapeutic decision‐making and clinical trials.

The Banff 2019 Kidney Meeting Report (I): Updates on and clarification of criteria for T cell- and antibody-mediated rejection.

The XV. Banff conference for allograft pathology was held in conjunction with the annual meeting of the American Society for Histocompatibility and Immunogenetics in Pittsburgh, PA (USA) and focused on refining recent updates to the classification, advances from the Banff working groups, and standardization of molecular diagnostics. This report on kidney transplant pathology details clarifications and refinements to the criteria for chronic active (CA) T cell–mediated rejection (TCMR), borderline, and antibody‐mediated rejection (ABMR). The main focus of kidney sessions was on how to address biopsies meeting criteria for CA TCMR plus borderline or acute TCMR. Recent studies on the clinical impact of borderline infiltrates were also presented to clarify whether the threshold for interstitial inflammation in diagnosis of borderline should be i0 or i1. Sessions on ABMR focused on biopsies showing microvascular inflammation in the absence of C4d staining or detectable donor‐specific antibodies; the potential value of molecular diagnostics in such cases and recommendations for use of the latter in the setting of solid organ transplantation are presented in the accompanying meeting report. Finally, several speakers discussed the capabilities of artificial intelligence and the potential for use of machine learning algorithms in diagnosis and personalized therapeutics in solid organ transplantation.

Banff Digital Pathology Working Group: Going digital in transplant pathology.

The Banff Digital Pathology Working Group (DPWG) was formed in the time leading up to and during the joint American Society for Histocompatibility and Immunogenetics/Banff Meeting, September 23‐27, 2019, held in Pittsburgh, Pennsylvania. At the meeting, the 14th Banff Conference, presentations directly and peripherally related to the topic of “digital pathology” were presented; and discussions before, during, and after the meeting have resulted in a list of issues to address for the DPWG. Included are practice standardization, integrative approaches for study classification, scoring of histologic parameters (eg, interstitial fibrosis and tubular atrophy and inflammation), algorithm classification, and precision diagnosis (eg, molecular pathways and therapeutics). Since the meeting, a survey with international participation of mostly pathologists (81%) was conducted, showing that whole slide imaging is available at the majority of centers (71%) but that artificial intelligence (AI)/machine learning was only used in ≈12% of centers, with a wide variety of programs/algorithms employed. Digitalization is not just an end in itself. It also is a necessary precondition for AI and other approaches. Discussions at the meeting and the survey highlight the unmet need for a Banff DPWG and point the way toward future contributions that can be made.

Editorial introductions

Current Opinion in Organ Transplantation was launched in 1996. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of organ transplantation is divided into 18 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Xian C. LiXian C. LiDr Xian C. Li is Professor of Immunology, Weill Cornell Medicine of Cornell University and director of Immunobiology &Transplant Sciences at Houston Methodist Hospital in Houston Texas. He also holds the Max and Lillie Frosch Centennial Chair at Houston Methodist. His lab studies the fundamental mechanisms of transplant rejection and transplant tolerance. The goal of his team is to advance transplant medicine through fundamental research. Dr. Xian Li is recognized with many awards and elected memberships; He received the American Society of Transplantation (AST) Young Investigator Award, AST Wyeth Basic Science Award, and the AST Wyeth Achievement Award. Dr. Li has served in the AST basic science advisory council, TTS basic science committee, chair of the AST Grants Executive Committee, and Chair of ATC 2018. He is an elected member of the American Society for Clinical Investigation, a standing member of the NIH study sections and DOD grant review panels. He is now an associate editor of American Journal of Transplantation and the journal of Transplantation. Linda C. CendalesLinda C. CendalesDr Linda C. Cendales, MD, is an Associate Professor of Surgery, a Duke Health Scholar, and the Director of the Vascularized Composite Allotransplantation at Duke University Medical Center. During her fellowship in Hand and Microsurgery, Dr Cendales helped organize the first VCA team in the U.S. and participated in the country's first two hand transplants in Louisville, KY. She was subsequently the first surgeon accepted into the Transplant Surgery and Immunobiology Fellowship at the National Institutes of Health (NIH). During her time at the NIH, Dr Cendales established and published a model of VCA in nonhuman primates and has one of the largest experiences in VCA in non-human primates reported in the scientific literature. She organized the first international symposium on VCA histopathology at the International Banff Conferences on Allograft Pathology leading to the published classification system now used as a standard for clinical reporting of rejection. Prior to joining Duke, Dr Cendales established the VCA program at Emory University and led the multi-disciplinary team that performed Georgia's first hand transplant in March 2011. While at Duke, Dr Cendales established the VCA program and led the multi-disciplinary team that performed North Carolina's first hand transplant and first bilateral hand transplant in May 2016 and in November 2018 respectively. Dr Cendales is the Principal Investigator of clinical and translational studies in VCA funded by the U.S. Department of Defense. Dr Cendales is an Associate Editor for the American Journal of Transplantation, is the Chair of the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) Vascularized Composite Allograft (VCA) Committee, and the co-chair elect of the American Transplant Congress, and the Past-President of the International Society of Vascularized Composite Allotransplantation Society (ISVCA). She has co-authored numerous scientific manuscripts, abstracts, and invited publications. Similarly, Dr Cendales has made countless presentations at national and international meetings.

Subclinical Inflammation in Renal Transplantation.

The standardization of renal allograft pathology began in 1991 at the first Banff Conference held in Banff, Alberta, Canada. The first task of transplant pathologists, clinicians, and surgeons was to establish diagnostic criteria for T-cell-mediated rejection (TCMR). The histological threshold for this diagnosis was arbitrarily set at "i2t2": a mononuclear interstitial cell infiltrate present in at least 25% of normal parenchyma and >4 mononuclear cells within the tubular basement membrane of nonatrophic tubules. TCMR was usually found in dysfunctional grafts with an elevation in the serum creatinine; however, our group and others found this extent of inflammation in "routine" or "protocol" biopsies of normally functioning grafts: "subclinical" TCMR. The prevalence of TCMR is higher in the early months posttransplant and has decreased with the increased potency of current immunosuppressive agents. However, the pathogenicity of lesser degrees of inflammation under modern immunosuppression and the relation between ongoing inflammation and development of donor-specific antibody has renewed our interest in subclinical alloreactivity. Finally, the advances in our understanding of pretransplant risk assessment, and our increasing ability to monitor patients less invasively posttransplant, promises to usher in the era of precision medicine.

Mapping Racial and Ethnic Studies in Canada: Retrospective and Prospective Views of Canadian Ethnic Studies Chairs

Mapping Racial and Ethnic Studies in Canada:Retrospective and Prospective Views of Canadian Ethnic Studies Chairs James Frideres (bio), Shibao Guo (bio), Abdie Kazemipur (bio), Morton Weinfeld (bio), and Lloyd Wong (bio) Introduction (Shibao Guo and Lloyd Wong) Canada has always been diverse with respect to 'race' and ethnicity. In 1901, only three decades after Confederation, the English and French comprised 57% and 31% of the Canadian population respectively (Coats 1931, 134). Thus, 12% of Canada's population were non-French and non-British with the majority being other Europeans such as German, Dutch, Scandinavian, Russian, and many others. However, quite significantly, 25% of the non-French and non-British were racialized minorities and these included First Nations, Chinese, Japanese, and Blacks. Thus, the claims and discourse of many publications in recent decades of "the changing face of Canada" are based on an imagined early Canada being white, and English and French (deux nations). The early scholarship on Canada's already established racial and ethnic diversity essentially had a static conceptualization of ethnicity (Burnet 1976) and this was exemplified in the work of Hughes (1943) and Porter (1965, 1975). Jean Burnet's critique fostered in a more dynamic notion of ethnicity and conceptualized it in terms of social relations. In a special issue of the journal Sociological Focus, which examined studies in Canada, Burnet (1976) examined, through this dynamic lens, the policy of multiculturalism within a bilingual framework. It should be noted that this special issue also featured many other prominent sociologists who examined topics related to immigration, race and ethnicity and these included Crysdale (1976), Clairmont and Wien (1976) and Richmond (1976). That same year Palmer (1976), who was one of the early editors of Canadian Ethnic Studies, provided a comparative analysis of immigration and ethnicity in Canada and the United States. By the late [End Page 1] 1970s and early 1980s, college and university courses on 'race' and ethnicity were standard fare with many of the popular textbooks being used with titles such as: Identities: The Impact of Ethnicity on Canadian Society (Isajiw 1977); Minority Canadians: Ethnic Groups (Krauter and Davis 1978); The Canadian Ethnic Mosaic: A Quest for Identity (Driedger 1978); Ethnicity in Canada: Theoretical Perspectives (Anderson and Frideres 1981); and Racial Minorities in Multicultural Canada (Li and Bolaria 1983). After this the floodgates were opened and the substantive area of ethnic studies started to flourish in Canada with a generation of scholars, most of whom were American- and British-trained, coming to Canada to study 'race', ethnicity, and immigration and to train a new generation of Canadian students. At the same time, the journal Canadian Ethnic Studies/Études éthniques au Canada was born in 1968, followed very shortly by the establishment of the Canadian Ethnic Studies Association/Société canadienne d'études éthniques. In the following decades of the '80s, '90s, and 2000s, the literature in these areas exploded as scholars wrote about immigration, different ethnic/racial groups and the dynamics of their experiences in Canadian society. Over the past several decades, there has been a continual literature that examines race and ethnicity in Canada from a more general and critical perspective, and recently these include the summarizing work of Henry and Tator (2010), Hier and Bolaria (2012), Satzewich and Liodakis (2013) and Fleras (2017). Last year, in the fall of 2018, the Canadian Ethnic Studies Association held its 25th conference in Banff, Alberta with the theme of Immigration, Ethnic Mobilities, and Diasporic Communities in a Transnational World. Within this broad theme there was an invitation for theoretical and empirically-based papers on more specific topics such as: • The future of immigration, ethnic studies, and multiculturalism • Intersections of immigration and race, class and gender • Voluntary and forced mobilities: Refugees and the Canadian state • Youth, ethnicity, and identity in multicultural Canada • Ethnic communities, global diasporas and transnationalism in Canada • "Homelands": Memories, reconstructions, returns and directions forward • Citizenship and belonging in transnational spaces • Gender, class, and ethnic intersections in transnationalism • The future of transnational and ethnic mobilities in an unsettled world In addressing the first topic above, regarding the future of immigration, ethnic studies, and multiculturalism, a special roundtable session was created for...

The International Population Data Linkage Network – Banff and Beyond

We write to you, here in the pages of the International Journal of Population Data Science, for the second time in our capacity of co-directors of the International Population Data Linkage Network (IPDLN – www.ipdln.org). Time has certainly passed quickly since our first communication, where we introduced ourselves, and discussed planned initiatives for our tenure as leads of the IPDLN. Our network’s scientific community is steadily growing and thriving in an era of heightened interest around all things ‘data’. Indeed, there is great enthusiasm for all initiatives that explore ways of harnessing information systems and multisource data to enhance collective knowledge of health matters so that better decisions can be made by governments, system planners, providers, and patients. Never before have such initiatives attracted more attention.&#x0D; It is in this context of heightened interest and relevance around IPDLN and its science that we prepare to convene in Banff, Alberta, Canada for the 5th biennial IPDLN Conference – September 11-14. The conference, to be held at the inspiring Banff Centre (www.banffcentre.ca), is almost sold out, with only limited space remaining for late registrants. A tremendous program has been created through the oversight of Scientific Program co-chairs, Drs. Astrid Guttman and Hude Quan. A compelling roster of plenary lectures from Drs. Diane Watson, Jennifer Walker, and Osmar Zaïane is eagerly anticipated, as are topical panel discussions, an entertaining Science Slam session, and a terrific social program. These sessions will be surrounded by rich scientific oral and poster presentations arising from the more than 450 scientific abstracts submitted for review. We are so pleased to see this vibrant scientific engagement from the IPDLN membership and students, and look forward to hosting all delegates in Banff.&#x0D; The Banff conference will also be the venue at which we announce the new Directorship of the IPDLN for the next two years (2019 and 2020). As co-directors, we engaged with a number of individuals and organizations with interest in leading the IPDLN. In the end, two compelling Directorship applications were submitted – one a joint bid from Australia’s Population Health Research Network and the South Australia Northern Territory DataLink, and the other from the US-based Actionable Intelligence for Social Policy. IPDLN members submitted votes on these strong leadership bids through an online voting process, and while the excellence and appeal of both bids was apparent in strong voter support for both, a winning bid has been confirmed, and it will (as mentioned) be announced at the upcoming September conference.&#x0D; As we look forward to the Banff meeting with great anticipation, we are compelled to acknowledge the growing IPDLN legacy created by past directors. We are particularly indebted to our immediate predecessor, Dr. David Ford, and his team at Swansea University. Their work in hosting the 2016 IPDLN conference has been an inspiration to us in the planning of this year’s conference, and their crucial and foundational work in creating an IT platform for the IPDLN website, the membership database, and the new International Journal for Population Data Science has brought the IPDLN to a new level of organizational sophistication. Over the last 18 months, our co-directorship teams from the Institute for Clinical Evaluative Sciences in Ontario and the O’Brien Institute for Public Health at the University of Calgary have built on the foundation established by prior directors to update/enhance the IPDLN website and membership database. The IPDLN has more members than ever before representing a greater number of countries, and we have a more formalized governance structure with the creation of an Executive Committee that will include immediate past-Directors in order to better ensure continuity. A new Executive Committee will be elected by the IPDLN membership following the Banff conference.&#x0D; The waiting is almost over and IPDLN 2018 is upon us! Our scientific domain has never had the prominence or level of anticipation that we currently see. And the IPDLN has grown in its size, vibrancy and scientific scope. The opportunities for us are boundless, and the timing of our upcoming conference could not be better. We are honoured, with our respective organizations, to have had this opportunity to serve as co-directors over the past two years, and look forward to seeing many of you very soon. For those of you who are unable to travel to Canada’s Rocky Mountains this year, we look forward to connecting with you at a later time in the IPDLN’s continuing upward journey.

Evolving criteria for the diagnosis of antibody-mediated rejection in renal allografts.

To review changes in the Banff schema for antibody-mediated renal allograft rejection over the past decade, including key revisions agreed upon during and immediately subsequent to the 2017 Banff Conference on Allograft Pathology. The original Banff schema for diagnosis of acute and chronic active antibody-mediated rejection (ABMR) in renal allografts was formulated at the 2001 and 2007 Banff Conferences, and required histologic (primarily microvascular inflammation and transplant glomerulopathy), immunohistologic (C4d in peritubular capillaries), and serologic [circulating donor-specific antibodies (DSA)] evidence for a definitive diagnosis of ABMR. This schema was updated at the 2013 Banff Conference, recognizing C4d-negative ABMR, intimal arteritis as a potential manifestation of ABMR, and revising definitions and thresholds for glomerulitis and transplant glomerulopathy to improve interobserver agreement and correlation with clinical, molecular, and serologic data. Compared with the 2007 criteria, Banff 2013 improved the sensitivity of the classification for diagnosing ABMR and the correlation of ABMR diagnosis with graft outcomes. At the 2017 Banff Conference, new modifications to the classification were discussed and have subsequently been agreed upon, accepting C4d and thoroughly validated molecular classifiers as surrogate markers for DSA. From a consensus reached at the 2017 Banff Conference, updated criteria for diagnosis of active and chronic active ABMR have been developed that recognize C4d and molecular classifiers as surrogate markers for DSA. In addition, specific recommendations for the use of molecular diagnostics in the diagnosis of ABMR were developed.

The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials.

The kidney sessions of the 2017 Banff Conference focused on 2 areas: clinical implications of inflammation in areas of interstitial fibrosis and tubular atrophy (i‐IFTA) and its relationship to T cell–mediated rejection (TCMR), and the continued evolution of molecular diagnostics, particularly in the diagnosis of antibody‐mediated rejection (ABMR). In confirmation of previous studies, it was independently demonstrated by 2 groups that i‐IFTA is associated with reduced graft survival. Furthermore, these groups presented that i‐IFTA, particularly when involving >25% of sclerotic cortex in association with tubulitis, is often a sequela of acute TCMR in association with underimmunosuppression. The classification was thus revised to include moderate i‐IFTA plus moderate or severe tubulitis as diagnostic of chronic active TCMR. Other studies demonstrated that certain molecular classifiers improve diagnosis of ABMR beyond what is possible with histology, C4d, and detection of donor‐specific antibodies (DSAs) and that both C4d and validated molecular assays can serve as potential alternatives and/or complements to DSAs in the diagnosis of ABMR. The Banff ABMR criteria are thus updated to include these alternatives. Finally, the present report paves the way for the Banff scheme to be part of an integrative approach for defining surrogate endpoints in next‐generation clinical trials.

Response: Queering Time

Response:Queering Time Deanna K. Kreisel (bio) There was an extraordinarily strong throughline to the papers at the 2017 NAVSA Conference in Banff. Perhaps it was due partly to the conference theme, "Victorian Preserves," partly to the breathtaking natural setting, and partly to our political moment that many of the presentations clustered around environmental and ecocritical themes. This striking thematic coherence made the job of a "NAVSA scout" with ecocritical interests both easy and difficult: easy in the sense that one could almost choose three papers at random and make a strong case for their interconnection, and difficult in the sense that it was very hard to choose from among the many excellent presentations on offer.1 In the end I selected the three papers in this cluster particularly because of the ways they speak to each other about a topic that has become of central interest to environmentalist criticism: the problem of futurity. While Fredric Jameson may be right that "Time and Space are at war in a Homeric combat," for literary critics it's hardly a fair fight (698). Every few years literature scholars are exhorted to execute a dialectical do-si-do and supplement their predominant way of reading with the putatively missing term: to reinvigorate their work with fresh approaches drawn from, for example, the study of geography, architecture, urban landscapes, and domestic interiors, or from the study of factory time, geological history, evolutionary biology, or classic narratological theory. Yet as that theory—from the Russian formalists to the work of Gérard Genette and Paul Ricoeur—has long shown, narrative is [End Page 236] fundamentally structured by time, is inherently a chronological, not a spatial, phenomenon. For Ricoeur, for example, "time becomes human time to the extent that it is organized after the manner of a narrative; narrative, in turn, is meaningful to the extent that it portrays the features of temporal experience" (3). While Jameson may have announced the "end of temporality" back in 2003, he did so by way of lamenting the eclipsing of literature by other art forms: "the rise of the intellectual stock of architecture accompanied the decline of belles lettres like a lengthening shadow" (696). But in the realm of the literary, space doesn't stand a chance. It is with some ambivalence, then, that I ask the readers of this cluster of papers to attend to questions of temporality before the most recent spatial turn has even completed its circuit around the dance floor. But Time, for better or worse, has bullied its way back into the spotlight—thanks in part to the efflorescence of ecocriticism, whose political project is both urgent and time-bound (from the vast temporal scales of geological change to the focus on our collective dys/utopian future as a planet), and in part to the extraordinary richness of the recent "temporal turn" in queer theory (particularly the work of Lee Edelman, Valerie Rohy, Jose Muñoz, Claire Colebrook, and Elizabeth Freeman). Two strains of this latter turn are particularly salient to the papers gathered here: the well-established interrogation of reproductive futurity and the more recent critique, from a queer perspective, of the regimentation of time under modernity. Dana Luciano has termed "chronobiopolitics" (9) the orchestrations of time through which people come to feel part of a collective, and Elizabeth Freeman has coined the term "chrononormativity" to refer to "the use of time to organize individual human bodies toward maximum productivity" (3). While only two of the three papers in this cluster are explicitly about queerness, and only one is about ecocriticism in a narrow sense, all three papers take fresh, surprising, and generative looks at the phenomenal and phenomenological category of time in ways that I think ultimately bear on ecocritial concerns, and thus pull together a significant thematic sub-thread of an already beautifully coherent conference. In her paper, "Saving Time: Nineteenth-Century Time Travel and the Temporal Logic of Late Capitalism," Sarah C. Alexander examines late-Victorian time travel narratives that describe temporal paradoxes, wherein a character travels to the past and alters events in a way that then affects the past, present, and future. Alexander focuses on the 1891 novel...

Counting Perron numbers by absolute value

AbstractWe count various classes of algebraic integers of fixed degree by their largest absolute value. The classes of integers considered include all algebraic integers, Perron numbers, totally real integers, and totally complex integers. We give qualitative and quantitative results concerning the distribution of Perron numbers, answering in part a question of Thurston [‘Entropy in dimension one’, to appear in the Proceedings of the Banff Conference on Frontiers in Complex Dynamics].

Lovable Losers: The Heike in Action and Memory ed. by Mikael S. Adolphson and Anne Commons

Reviewed by: Lovable Losers: The Heike in Action and Memory ed. by Mikael S. Adolphson and Anne Commons Linda H. Chance (bio) Lovable Losers: The Heike in Action and Memory. Edited by Mikael S. Adolphson and Anne Commons. University of Hawai’i Press, Honolulu, 2015. xviii, 284 pages. $55.00. What would we do without conference volumes? Although every meeting convener hears that this genre is not welcome at most publishers, when well done, as with the present book, we reap a concrete exemplar of the inter-disciplinary that Japan studies, at its best, aspires to. This book is chock full of useful, definitive essays that display scrupulous scholarship, broad thinking, and interconnectedness. Everyone involved with Lovable Losers deserves huzzahs for sticking to the promise of the original conference in Banff, Alberta, over the four years it took to get to press. The editors/organizers, Mikael Adolphson and Anne Commons, tell us that Banff was an apt setting for “frequent and concentrated discussions in both formal and informal situations” (p. ix); no reader can doubt that was true, nor fail to be glad of it. Research in English on the late Heian period, and specifically that which uses the magnificent Heike monogatari account of the Genpei War between the Taira and Minamoto as a lens, has blossomed over the last ten years. No fewer than three monographs and a dozen new articles mean that scholars and students alike can find answers to almost every question on the Heike. What’s more, we are no longer limited to treatments of the popular edition, the Kakuichi variant; we can immerse ourselves in the early Engyō edition, the Genpei jōsuiki, or the rival Azuma kagami. This volume enfolds and expands on the present critically nuanced field to solid effect. Among many things it does well is to explain such terminological choices as their reference to the “Ise Taira” (to distinguish them from other Taira lineages) until the rise of Kiyomori and his relatives to the elite, when they become the “house of the Taira,” i.e., the Heike. The book seeks to engage two big questions. First, how did the Heike act in their own day? The answers are deeply revisionist, showing that many have misconstrued their impact on the late twelfth century. Second, how have the Heike been remembered (which has naturally had something to do with the blind spots we have about the ways they behaved)? This is only a convenient binary, however, as the volume editors aver in their opening essay, “Blurring the Lines.” How the Taira were and how later generations represent the Taira are bound up with one another, just as the historical disciplines that take the actual as their concern and disciplines that focus on the aesthetics and rhetorics of presentation each cannot do without the [End Page 132] insights of the other. Reviews in a recent volume of this journal (Vol. 42, No. 1; Winter 2016) contained mild grumbling by the historians David Spafford and Bruce Batten about the treatment of history by literary scholars; as a “literature person,” I feel the present book leans heavily toward historical thinking even when taking religion, say, as the subject, while its historians are attentive to literary discourses and play (in the good sense) with literary adaptations. Thus, it comes closer to the successful interdisciplinary parsing of its topics than some monographs. The book clarifies precisely how and why we need to think of the Heike as warrior-aristocrats, marshaling both historical and literary evidence. Contributors make a strong case for the Heike leader Kiyomori’s success in blending conservative strategies that pay due respect to the reigning hierarchy with innovations that gained him attention. Each of the authors seems to have gotten the memos on these overarching themes and gives cross-references, producing a coherent work of scholarship. The first three chapters on “The Heike in Action” serve as a suite on Kiyomori’s decision to move to a new capital at Fukuhara, near the port of Ōwada no tomari. Led off strongly in “Fukuhara: Kiyomori’s Lost Capital” by Adolphson championing the thesis that Kiyomori had ambitions to establish a new imperial line there headed by...

The XIIIth Banff Conference on Allograft Pathology: The Banff 2015 Heart Meeting Report: Improving Antibody-Mediated Rejection Diagnostics: Strengths, Unmet Needs, and Future Directions.

The 13th Banff Conference on Allograft Pathology was held in Vancouver, British Columbia, Canada from October 5 to 10, 2015. The cardiac session was devoted to current diagnostic issues in heart transplantation with a focus on antibody‐mediated rejection (AMR) and small vessel arteriopathy. Specific topics included the strengths and limitations of the current rejection grading system, the central role of microvascular injury in AMR and approaches to semiquantitative assessment of histopathologic and immunophenotypic indicators, the role of AMR in the development of cardiac allograft vasculopathy, the important role of serologic antibody detection in the management of transplant recipients, and the potential application of new molecular approaches to the elucidation of the pathophysiology of AMR and potential for improving the current diagnostic system. Herein we summarize the key points from the presentations, the comprehensive, open and wide‐ranging multidisciplinary discussion that was generated, and considerations for future endeavors.