AUTHOR=Afrouzian Marjan , Kozakowski Nicolas , Liapis Helen , Broecker Verena , Truong Luan , Avila-Casado Carmen , Regele Heinz , Seshan Surya , Ambruzs Josephine M. , Farris Alton Brad , Buob David , Chander Praveen N. , Cheraghvandi Lukman , Clahsen-van Groningen Marian C. , de Almeida Araujo Stanley , Ertoy Baydar Dilek , Formby Mark , Galesic Ljubanovic Danica , Herrera Hernandez Loren , Honsova Eva , Mohamed Nasreen , Ozluk Yasemin , Rabant Marion , Royal Virginie , Stevenson Heather L. , Toniolo Maria Fernanda , Taheri Diana TITLE=Delphi: A Democratic and Cost-Effective Method of Consensus Generation in Transplantation JOURNAL=Transplant International VOLUME=36 YEAR=2023 URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.11589 DOI=10.3389/ti.2023.11589 ISSN=1432-2277 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.