Grading of Acute Pancreas Allograft Rejection
Pancreas Transplantation

Grading of Acute Pancreas Allograft Rejection
Grade Histopathology
Grade 0 (NORMAL) Unremarkable pancreatic parenchyma without inflammatory infiltrates
Grade I (INFLAMMATION OF UNDETERMINED SIGNIFICANCE) Sparse, purely septal mononuclear inflammatory infiltrates. No venous endotheliitis or acinar involvement identified
Grade II (MINIMAL) Purely septal inflammation with venous endotheliitis (attachment of lymphocytes to the endothelium with associated endothelial damage and lifting of the endothelium from the basement membrane).

In the absence of venous endotheliitis a constellation of at least 3 of the following 4 histologic features:

  1. Septal inflammatory infiltrates composed of a mixed population of small and large ("activated") lymphocytes
  2. Eosinophils
  3. Acinar inflammation in rare (up to 2) foci
  4. Ductal inflammation (permeation of inflammatory cells through the ductal basement membrane)
Grade III (MILD) Septal inflammatory infiltrates composed of a mixed population of small and large ("activated") lymphocytes with associated acinar inflammation in multiple (3 or more) foci. Eosinophils, venous endotheliitis, ductal inflammation and evidence of acinar single cell injury may be seen depending on sampling. The latter is manifested as cellular drop-out (apoptosis-pyknotic cell death), or necrosis (oncotic cell death)
Grade IV (MODERATE) Arterial endotheliitis and/or necrotizing arteritis (vasculitis). Features described in Grade III are usually present
Grade V (SEVERE) Extensive acinar lymphoid or mixed inflammatory infiltrates with multicellular focal or confluent acinar cell necrosis. Depending on sampling vascular and ductal lesions may be demonstrated
Reference Drachenberg CB, Papadimitriou JC, Klassen DK, et al. Evaluation of pancreas transplant needle biopsy: reproducibility and revision of histologic grading system. Transplantation 1997;63(11):1579-1586


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