Abstract
Protocol surveillance endomyocardial biopsies are performed to assess for rejection and thus allow the treatment of rejection prior to symptomatic cardiac dysfunction. The biopsies are performed with decreasing frequency post-transplant, usually stopping at 1–3 years post-transplant. A standardised method of grading was introduced in 1990 under the auspices of the International Society for Heart and Lung Transplantation (ISHLT), which was simplified based on clinical outcome data in 2005. The 2005 ISHLT grading scheme is a four-grade system, differentiated from the 1990 grades by an “R”, for revised, after the grade. It ranges from grade 0R, no rejection, to 3R, severe rejection. Mild (grade 1R) rejection is characterised by a mononuclear cell infiltrate with no more than a single focus of muscle damage, moderate (grade 2R) rejection having two or more foci with muscle damage, and severe (grade 3R) rejection has extensive muscle damage with oedema and haemorrhage.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Angelini A, Andersen CB, Bartoloni G, Black F, Bishop P, Doran H, et al. A web-based pilot study of inter-pathologist reproducibility using the ISHLT 2004 working formulation for biopsy diagnosis of cardiac allograft rejection: the European experience. J Heart Lung Transplant. 2011;30(11):1214–20.
Billingham ME. Some recent advances in cardiac pathology. Hum Pathol. 1979;10(4):367–86.
Billingham ME, Cary NR, Hammond ME, Kemnitz J, Marboe C, McCallister HA, et al. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Heart Rejection Study Group. The International Society for Heart Transplantation. J Heart Transplant. 1990;9(6):587–93.
Maleszewski JJ, Kucirka LM, Segev DL, Halushka MK. Survey of current practice related to grading of rejection in cardiac transplant recipients in North America. Cardiovasc Pathol. 2011;20(5):261–5.
Michaels PJ, Kobashigawa J, Laks H, Azarbal A, Espejo ML, Chen L, et al. Differential expression of RANTES chemokine, TGF-beta, and leukocyte phenotype in acute cellular rejection and quilty B lesions. J Heart Lung Transplant. 2001;20(4):407–16.
Miller CA, Fildes JE, Ray SG, Doran H, Yonan N, Williams SG, et al. Non-invasive approaches for the diagnosis of acute cardiac allograft rejection. Heart. 2013;99(7):445–53.
Neil D. Transplant pathology. In: Suvarna SK, editor. Cardiac pathology. London: Springer; 2013. p. 163–81.
Sattar HA, Husain AN, Kim AY, Krausz T. The presence of a CD21+ follicular dendritic cell network distinguishes invasive Quilty lesions from cardiac acute cellular rejection. Am J Surg Pathol. 2006;30(8):1008–13.
Sharples LD, Cary NR, Large SR, Wallwork J. Error rates with which endomyocardial biopsy specimens are graded for rejection after cardiac transplantation. Am J Cardiol. 1992;70(4):527–30.
Spiegelhalter DJ, Stovin PG. An analysis of repeated biopsies following cardiac transplantation. Stat Med. 1983;2(1):33–40.
Stewart S, Cary NRB. The pathology of heart and lung transplantation. Curr Diagn Pathol. 1996;3(2):69–79.
Stewart S, Winters GL, Fishbein MC, Tazelaar HD, Kobashigawa J, Abrams J, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant. 2005;24(11):1710–20.
Tan CD, Baldwin III WM, Rodriguez ER. Update on cardiac transplantation pathology. Arch Pathol Lab Med. 2007;131(8):1169–91.
Yang HM, Lai CK, Gjertson DW, Baruch-Oren T, Ra SH, Watts W, et al. Has the 2004 revision of the International Society of Heart and Lung Transplantation grading system improved the reproducibility of the diagnosis and grading of cardiac transplant rejection? Cardiovasc Pathol. 2009;18(4):198–204.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Neil, D.A.H., Rice, A.J. (2016). Pathology of Acute Cellular Rejection. In: Leone, O., Angelini, A., Bruneval, P., Potena, L. (eds) The Pathology of Cardiac Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-46386-5_13
Download citation
DOI: https://doi.org/10.1007/978-3-319-46386-5_13
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-46384-1
Online ISBN: 978-3-319-46386-5
eBook Packages: MedicineMedicine (R0)