The International Society for Heart and Lung Transplantation (ISHLT) has developed a grading system for cardiac transplant rejection based on the histologic examination of a heart biopsy.
|
Grade |
Descriptor |
|
0 |
no acute rejection |
|
1A |
focal, mild acute rejection |
|
1B |
diffuse, mild acute rejection |
|
2 |
focal, moderate acute rejection |
|
3A |
multifocal moderate rejection |
|
3B |
diffuse, borderline severe acute rejection |
|
4 |
severe acute rejection |
|
Inflammatory Cell Infiltrate |
Myocyte Damage and Other Findings |
Grade |
|
none |
none |
0 |
|
focal perivascular or focal interstitial infiltrate of large, reactive lymphocytes |
none |
1A |
|
diffuse but sparse interstitial infiltrate of large, reactive lymphocytes |
none |
1B |
|
one focus of aggressive lymphocytic infiltrate, AND/OR |
AND/OR, single focus of myocyte damage |
2 |
|
multifocal aggressive infiltrates of large, reactive lymphocytes, AND/OR |
AND/OR multifocal myocyte damage |
3A |
|
diffuse lymphocytic infiltrate with either eosinophils or granulocytes |
multifocal myocyte damage, with necrosis |
3B |
|
diffuse, aggressive inflammatory cell infiltrate with large, reactive lymphocytes, eosinophils and neutrophils |
extensive myocyte damage with necrosis; often with edema, hemorrhage and/or vasculitis |
4 |
Limitations
• It may be difficult to identify myocyte damage.
• It does not take into account the number of biopsy fragments showing evidence of rejection.
• Grade 2 rejection may be mimicked by a variety of phenomenon.
Specialty: Cardiology, Surgery, general
