McMallister et al used histologic features in an endomyocardial biopsy to grade the severity of cardiac allograft rejection. This can help identify those patients who require aggressive management to prevent rejection. The authors are from the Texas Heart Institute and St. Luke's Episcopal Hospital in Houston.
Parameters:
(1) nature of mononuclear cell infiltrate (includes lymphocytes)
(2) myocyte degeneration
(3) neutrophilic (polymorphonuclear leukocytes)
|
Mononuclear Cell Infiltrate |
Myocyte Degeneration |
Neutrophils |
Grade |
|
none |
none |
none |
0 |
|
perivascular, few |
none |
none |
1 |
|
perivascular, many |
none |
none |
2 |
|
perivascular with extension into interstitium |
none |
none |
3 |
|
predominantly interstitial |
rare |
none |
4 |
|
predominantly interstitial |
few |
none |
5 |
|
predominantly interstitial |
patchy |
none |
6 |
|
predominantly interstitial |
diffuse |
none |
7 |
|
predominantly interstitial |
extensive |
none |
8 |
|
extensive interstitial |
extensive |
mild to moderate |
9 |
|
extensive interstitial |
extensive |
extensive |
10 |
where:
• It looks to me as if there are too many levels between 4 to 8. It would be interesting to see how observers vary in their interpretation in this range.
|
Grade |
Degree of Rejection |
|
0 |
none |
|
1 to 3 |
mild |
|
4 to 8 |
moderate |
|
9 to 10 |
severe |
Specialty: Cardiology
ICD-10: ,
