Drachenberg et al graded acute rejection of a pancreatic transplant based on histopathologic features. The authors are from the University of Maryland in Baltimore.
Parameters:
(1) septal inflammation
(2) inflammation involving acini
(3) endothelial inflammation and/or vasculitis
(4) number of associated findings
|
Septal Inflammation |
Inflammation in Acini |
Vascular Inflammation |
Associated Findings |
Grade |
|
present |
absent |
absent |
0 |
1 |
|
absent |
present |
absent |
0 |
1 |
|
present |
variable |
absent |
1 or 2 |
1 to 2 |
|
present |
variable |
absent |
3 or 4 |
2 |
|
present |
NA |
venous endothelialitis |
NA |
2 |
|
present with monocytes & activated lymphocytes |
>= 3 foci |
NA |
NA |
3 |
|
NA |
NA |
arteritis (intimal and/or necrotizing) |
NA |
4 |
|
NA |
extensive with multifocal or confluent necrosis |
NA |
NA |
5 |
Associated findings:
(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
|
Grade |
Descriptive Term |
|
0 |
absent |
|
1 |
indeterminate |
|
2 |
minimal rejection |
|
3 |
mild rejection |
|
4 |
moderate rejection |
|
5 |
severe rejection |
The percent of grafts lost to pure immunologic mechanism increases with increasing grade, from 0% with Grade 1 to 100% for Grade 5.
Specialty: Gastroenterology, Surgery, general
