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Correspondence: Marjan Afrouzian, maafrouz@utmb.edu

Author contributions: MA designed the study and acted as facilitator for Delphi. MA and HL conceived the study and selected cases for validation. HL supervised the study. NK, VB, LT, CA-C, HR, JA, AF, DB, PC, MC-vG, SdA, DE, MF, DG, EH, NM, YO, MR, VR, HS, and DT participated as panelists, suggested the initial 338 criteria, participated in Delphi consensus rounds and performed two validation rounds on 37 cases. EH, VB, LT, CA-C, JA, NK, MC-vG, SdA, and SS provided crucial contribution by submitting cases. LC performed data collection and participated in data analysis. SS contributed to the development of the initial framework. MA, NK, and HL reviewed the results of R9 and wrote the manuscript. VB, LT, CA-C, HR, JA, and AF critically reviewed, commented on, and edited the manuscript. MA and NK acquired funding for the research. All authors contributed to the article and approved the submitted version.

Acknowledgements: The authors would like to acknowledge the support of Dr. Reza Alaghehbandan for statistical analysis of R5 data, and Dr. Michael Mengel for helpful discussions and suggestions.

Competing interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Subject:

Research Funding:

The authors declare that this study received funding from Alexion Pharmaceuticals (grant # 100288) and the Banff Foundation on Allograft Pathology (for publication fees).

Keywords:

  • delphi
  • banff
  • thrombotic microangiopathy
  • kidney
  • transplantation

Delphi: A Democratic and Cost-Effective Method of Consensus Generation in Transplantation

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Journal Title:

Transplant International

Volume:

Volume 36

Publisher:

, Pages 11589-None

Type of Work:

Article | Final Publisher PDF

Abstract:

The Thrombotic Microangiopathy Banff Working Group (TMA-BWG) was formed in 2015 to survey current practices and develop minimum diagnostic criteria (MDC) for renal transplant TMA (Tx-TMA). To generate consensus among pathologists and nephrologists, the TMA BWG designed a 3-Phase study. Phase I of the study is presented here. Using the Delphi methodology, 23 panelists with >3 years of diagnostic experience with Tx-TMA pathology listed their MDC suggesting light, immunofluorescence, and electron microscopy lesions, clinical and laboratory information, and differential diagnoses. Nine rounds (R) of consensus resulted in MDC validated during two Rs using online evaluation of whole slide digital images of 37 biopsies (28 TMA, 9 non-TMA). Starting with 338 criteria the process resulted in 24 criteria and 8 differential diagnoses including 18 pathologic, 2 clinical, and 4 laboratory criteria. Results show that 3/4 of the panelists agreed on the diagnosis of 3/4 of cases. The process also allowed definition refinement for 4 light and 4 electron microscopy lesions. For the first time in Banff classification, the Delphi methodology was used to generate consensus. The study shows that Delphi is a democratic and cost-effective method allowing rapid consensus generation among numerous physicians dealing with large number of criteria in transplantation.

Copyright information:

© 2023 Afrouzian, Kozakowski, Liapis, Broecker, Truong, Avila-Casado, Regele, Seshan, Ambruzs, Farris, Buob, Chander, Cheraghvandi, Clahsen-van Groningen, de Almeida Araujo, Ertoy Baydar, Formby, Galesic Ljubanovic, Herrera Hernandez, Honsova, Mohamed, Ozluk, Rabant, Royal, Stevenson, Toniolo and Taheri.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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