The Future of Banff Meetings and the Banff

Foundation for Allograft Pathology Kim Solez, MD

Twenty-two years ago Kim Solez and Lorraine Racusen presided over a unique Meeting in Banff Canada.

Images from 1991

The Banff Schema

.

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.

The Banff Process

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 earlier this year

BANFF Conferences On Allograft Pathology 1991-Forever?

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).

BANFF Classification - Milestones

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 Istanbul and Barcelona 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.

“You Can’t Go Home Again” (Or can you?)

Run like Autodesk Design Night. Best. Salon. Ever. March1, 2014. Hosted by media professional

Dr. Julielynn Wong of Singularity U. Analogous to Paris Salon of a

century ago which moved Western

thought and culture forward, music,

art, good conversation, something unique,

innovative, and memorable!

Local Fund-Raising - Edmonton Salon Fund Raiser at Art Gallery of Alberta

Banff Articles in the Transplant Literature From gopubmed.org

86% Kidney clinical6% Liver clinical5% Kidney experimental1% 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.

Citation Analysis

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.

Standardization Of Tx Biopsy Interpretation - BANFF Classification

Isolated v-lesionWorking Group

IHC Quality Assurance Working Group

Glomerular LesionWorking 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 ABMRWorking Group

Isolated V lesion – Banu Sis and Ed Kraus Fibrosis scoring – Robert ColvinPolyoma virus staging – Volker NickeleitGlomerular lesion scoring – Mark HaasMolecular pathology – Phil HalloranQuality assurance IHC – Michael MengelC4d neg. Ab-Mediated Rejection – Banu SisHistory&Impact of Banff Process – Kim Solez

Working Groups

New Working Group on History and Impact of Banff Process

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.

Future Concepts

Future concepts of where technology is taking us are incorporated into long term planning of Banff Process.

They are part of 2013 Banff meeting in Brazil.

We should proactively address the challenges of the future, not be passive victims of events, keep ahead of the game.

BANFF Governance Structure - Before 2013 we have

had none beyond Drs. Racusen and Solez.

Formed Swiss foundation legal entity in 2013, the Banff Foundation for Allograft Pathology.

Objective of 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.

Scope of Banff Foundation for Allograft Pathology

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

Board of Directors 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/TreasurerResponsible for day-to-day business/activities of the Banff Foundation

for Allograft Pathology and annual reportingIs a member of the board and regularly reports to the other board

members Prepares annual budget and projections Monitors expensesWorks 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

Scientific program committee

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 BODterms of membership four years (i.e. two meetings),

renewable through majority vote of the board

Organ Steering committees

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

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 will ask you to consider the very different life of David Crippen, my counterpart in critical care medicine. We need to consider changes that large!

In Our Original Location We Had Mule Deer Poking Their

Heads into the Meeting Rooms!

We’ve come a long way!