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.

Ain Shams University Egypt

Armed Forces College of Medicine Cairo Egypt

Beth Israel Deaconess Medical Center Harvard Boston Massachusetts USA

Centenary Institute Camperdown Australia

Centre for Inflammation Research University of Edinburgh Edinburgh Scotland and Department of Pathology Edinburgh Royal Infirmary Edinburgh Scotland

Cleveland Clinic Cleveland Ohio USA

Dallas VA Medical Center and University of Texas Southwestern Department of Medicine Dallas Texas USA

Dept of Gastroenterology Hepatology Infectious Diseases and Endocrinology Hannover Medical School Hannover Germany

Division of Transplantation Surgery Mayo Clinic Rochester Minnesota USA

Duke University DUMC Durham North Carolina USA

Faculty of Medicine University of Alexandria Egypt

Hadassah Hebrew University Medical Center Jerusalem Israel

Hospital of Paris France

Institute for Clinical and Experimental Medicine Prague Czechia

Institute of Liver Studies King's College Hospital London United Kingdom

Kyoto University Kyoto Japan

Mount Sinai New York New York USA

Northwestern Medicine Chicago Illinois USA

NSW Government Health North Sydney New South Wales Australia

Oslo University Norway

Pathology Columbia University Irving Medical Center New York New York USA

Pathology Emory University Hospital Atlanta Georgia USA

Pathology Icahn School of Medicine Mount Sinai New York New York USA

Pathology Mayo Clinic Arizona Scottsdale Arizona USA

Pathology UCLA Health Los Angeles California USA

Pathology University of Ege Imir Bornova Turkey

Pathology University of Toronto Canada

Recanati Miller Transplantation Institute Mount Sinai Medical Center New York New York USA

Texas Children's Hospital Houston Texas USA

Toulouse University Hospital Toulouse France

Uchicago Medicine Department of Pathology Chicago Illinois USA

Uchicago Medicine Department of Surgery Chicago Illinois USA

UCSF Health Department of Surgery San Francisco California USA

University Health Network Toronto Canada

University Hospital of Padova Italy

University Hospitals Birmingham NHS Foundation Trust United Kingdom

University of Kansas Medical Center Kansas City Kansas USA

University of Miami Hospital Miami Florida USA

University of Minnesota Medical School Department of Pathology Minneapolis Minnesota USA

University of Pittsburgh Medical Center Department of Pathology Pittsburgh Pennsylvania USA

University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA

UTMB Health Galveston Texas USA

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