Minimal rejection is characterized by perivenular inflammatory infiltrates composed of small and large "activated" appearing lymphocytes. The inflammatory cells attach to the endothelium and cause endothelial damage with lifting of the endothelial cells from the basement membrane. Perivascular infiltrates not associated with endotheliitis are not specific for rejection and they are commonly seen in chronic pancreatitis. On the other hand, mild venous endotheliitis may be seen in other situations such as CMV pancreatitis. Rejection should be diagnosed and graded after other possible causes of graft inflammation have been ruled.
Due to sampling variations and to increase the sensitivity for the diagnosis of rejection, in the absence of venous endotheliitis minimal rejection is diagnosed in the presence of 3 of the following 4 features:
Septal inflammation composed of "activated" lymphocytes
Eosinophils
Focal acinar inflammation
Ductal inflammation
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