Grading Criteria of Billingham for Acute Rejection of a Heart Transplant (Stanford Criteria)

Description

Billingham developed criteria for grading the severity of acute rejection in patients with cardiac transplant. This can help identify patients who may benefit from aggressive immunosuppressive therapy. The author is from Stanford University.

Parameters:

(1) endocardial and/or interstitial edema

(2) perivascular infiltrate

(3) endocardial infiltrate

(4) interstitial infiltrate

(5) nature of infiltrate including methyl green pyronin staining

(6) myocytes

(7) other findings

Parameter	No Histologic Features	Mild Rejection	Moderate Rejection
edema	none	present	present
perivascular infiltrate	none	mild	mild to moderate
endocardial infiltrate	none	mild	mild to moderate
interstitial infiltrate	none	none	mild
nature of infiltrate	none	pyrinophilic mononuclear cells	predominantly pyrinophilic mononuclear cells
myocytes	normal	normal	focal damage
other finding	none	none	none

Parameter	Severe Rejection	Resolving or Resolved
edema	present	deceased or absent
perivascular infiltrate	moderate to severe	deceased or absent
endocardial infiltrate	moderate to severe	deceased or absent
interstitial infiltrate	moderate to severe	deceased or absent
nature of infiltrate	neutrophils present	nonpyrinophilic mononuclear cells
myocytes	necrosis present
other finding	interstitial hemorrhage	fibrosis or scar; lipofuscin

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Description

Specialty

ICD-10