Kidney Research and Clinical Practice 2020 Mar; 39(1): 17-31  
Diagnosis of renal transplant rejection: Banff classification and beyond
Hyeon Joo Jeong
Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
Correspondence to: Hyeon Joo Jeong
Department of Pathology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. E-mail:

Edited by Beom Jin Lim, Yonsei University, Seoul, Republic of Korea
Received: January 8, 2020; Revised: February 10, 2020; Accepted: February 19, 2020; Published online: March 31, 2020.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Diagnosis of renal transplant rejection is dependent on interpretation of renal allograft biopsies. The Banff Classification of Allograft Pathology, which was developed as a standardized working classification system in 1991, has contributed to the standardization of definitions for histologic injuries resulting from renal allograft rejections and provided a universal grading system for assessing these injuries. It has also helped to provide insight into the underlying pathogenic mechanisms that contribute to transplant rejection. In addition to histological and immunologic parameters, molecular tools are now being used to facilitate the diagnosis of rejection. In this review, I will discuss morphologic features of renal transplant rejections as well as major revisions and pitfalls of the Banff classification system, and provide future perspectives.
Keywords: Banff classification, Gene transcripts, Morphology, Renal transplantation, Rejection


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