The 16th Banff Meeting for Allograft Pathology was held in Banff, Alberta, Canada, from 19th-23rd September 2022. There was also a pre-meeting session to celebrate the 30th anniversary, held on ‘the past, present, and future of the Banff Classification’, including biopsy-based transcript diagnostics. A key focus of Banff 2022 is “A Re-appraisal of Microvascular Inflammation as a pathology lesion and its diagnostic specificity”. They proposed two new entities. "Probable antibody-mediated rejection (AMR)" and "Microvascular inflammation (MVI), DSA-negative and C4d-negative". Although biopsy-based transcript diagnostics are considered promising and remain an integral part of the Banff Classification (limited to diagnosis of AMR), more work needs to be done to agree on the exact classifiers, thresholds, and clinical context of use. • Probable AMR In the positive of circulating DSA, individual lesions of MVI below the histological threshold for MVI (g+ptc<2) and in the absence of C4d deposition in peritubular capillaries, probably indicate antibody activity; with Banff 2019 criteria this was ‘No AMR ’. This can be diagnosed in patients with normal or abnormal kidney function. Depending on the clinical context, antibody-targeted treatment could be considered. • MVI, DSA-negative and C4d-negative MVI above the histological threshold, without circulating DSA and with negative C4d staining in peritubular capillaries has been observed in patients with normal or abnormal kidney function; diagnosed as ‘No AMR with Banff 2019 criteria’. This is a purely descriptive category, and the causes may represent autoreactive or alloreactive non-HLA antibodies. • References Naesens M, et al. Am J Transplant. 2024 Mar;24(3):338-349. Roufosse C, et al. Am J Transplant. 2024 Mar;24(3):350-361.