Drachenberg et al graded acute rejection of a pancreatic transplant based on histopathologic features. The authors are from the University of Maryland in Baltimore.
(1) septal inflammation
(2) inflammation involving acini
(3) endothelial inflammation and/or vasculitis
(4) number of associated findings
Inflammation in Acini
1 or 2
1 to 2
3 or 4
present with monocytes & activated lymphocytes
>= 3 foci
arteritis (intimal and/or necrotizing)
extensive with multifocal or confluent necrosis
(1) presence of activated lymphocytes in the septae
(2) eosinophils in the inflammatory infiltrate
(3) 1 to 2 foci of acinar inflammation
(4) inflammation infiltrating the ducts
The percent of grafts lost to pure immunologic mechanism increases with increasing grade, from 0% with Grade 1 to 100% for Grade 5.
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Specialty: Gastroenterology, Surgery, general