The Hannover classification for cardiac allograft rejection can be used to describe the severity of acute rejection. The classification is a modification of the Billingham scheme. The authors are from Hannover Medical School in Lower Saxony.
Parameters:
(1) interstitial and endocardial edema
(2) inflammatory cell infiltrate, endocardial
(3) inflammatory cell infiltrate, perivascular
(4) inflammatory cell infiltrate, interstitial
(5) myocyte change
(6) vasculopathy
(7) granulation tissue
Acute Evolving
|
Findings |
A-0 |
A-1 |
A-2 |
|
edema |
none |
present |
present |
|
endocardial infiltrate |
none |
slight, mononuclear cells |
slight, mononuclear cells |
|
perivascular infiltrate |
none |
slight, mononuclear cells |
slight, mononuclear cells |
|
interstitial infiltrate |
none |
none |
slight, mononuclear cells |
|
myocyte change |
none |
none |
retrogressive changes |
|
vasculopathy |
none |
none |
none |
|
granulation tissue and fibrosis |
none |
none |
none |
where:
• Retrogressive changes in myocytes include perinuclear halo, splitting or branching of myocytes and increased contraction bands.
|
Findings |
A-3 |
A-4 |
|
edema |
present |
present |
|
endocardial infiltrate |
moderate |
marked, mixed |
|
perivascular infiltrate |
moderate |
marked, mixed |
|
interstitial infiltrate |
moderate |
marked, mixed |
|
myocyte change |
focal necrosis |
diffuse degeneration and necrosis |
|
vasculopathy |
none |
present |
|
granulation tissue and fibrosis |
none |
none |
Acute Resolving
|
Findings |
A-5a |
A-5b |
|
edema |
decreasing |
decreasing |
|
endocardial infiltrate |
decreasing |
decreasing |
|
perivascular infiltrate |
decreasing |
decreasing |
|
interstitial infiltrate |
decreasing |
decreasing |
|
granulation tissue |
early, capillarized |
organizing |
|
fibrosis |
proliferation of fibroblasts with reticulin fibers |
fibrosis with collagen fibers |
|
other findings |
|
hemosiderin |
Specialty: Cardiology
ICD-10: ,
