Standardized Cardiac Biopsy Grading
Heart Transplantation

Standardized Cardiac Biopsy Grading
Grade Histopathological Findings
0 No rejection
1 (1A or 1B) A = Focal (perivascular or interstitial) infiltrate without necrosis
B = Diffuse but sparse infiltrate without necrosis
2 One focus only with aggressive infiltration and/or focal myocyte damage
3 (3A or 3B) A = Multifocal aggressive infiltrates and/or myocyte damage
B = Diffuse inflammatory process with necrosis
4 Diffuse aggressive polymorphous ± infiltrate ± edema, ± hemorrhage, ± vasculitis, with necrosis
Additional Required Information*
  • Biopsy less than 4 pieces
  • Humoral rejection (positive IF, vasculitis, or severe edema in absence of cellular infiltrate
  • "Quilty" effect (Type A or Type B)
A = No myocyte encroachment
B = With myocyte encroachment
A = Up to 3 weeks posttransplant
B = Late ischemia
  • Infection present - biopsy therefore uninterpretable
  • Other (specify)
* Must be added to biopsy report if present
Reference Billingham ME, et al. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: heart rejection study group. J Heart Trans 1990;9(6):587-93.


Last Modified: Thu Jun 18 10:14:08 EDT 2009