REJECTION ACTIVITY INDEX (RAI)
|
Criteria which can be used to score liver allograft
biopsies with acute rejection, as defined by the World
Gastroenterology Consensus Document.
|
Category |
Criteria |
Score |
Portal Inflammation |
Mostly lymphocytic inflammation involving, but
not noticeably expanding, a minority of the triads |
1 |
Expansion of most or all of the triads, by a
mixed infiltrate containing lymphocytes with occasional blasts,
neutrophils and eosinophils |
2 |
Marked expansion of most or all of the triads by
a mixed infiltrate containing numerous blasts and eosinophils with
inflammatory spillover into the periportal parenchyma |
3 |
Bile Duct Inflammation Damage |
A minority of the ducts are cuffed and
infiltrated by inflammatory cells and show only mild reactive changes
such as increased nuclear:cytoplasmic ratio of the epithelial cells |
1 |
Most or all of the ducts infiltrated by
inflammatory cells. More than an occasional duct shows degenerative
changes such as nuclear pleomorphism, disordered polarity and
cytoplasmic vacuolization of the epithelium |
2 |
As above for 2, with most or all of the ducts
showing degenerative changes or focal lumenal disruption |
3 |
Venous Endothelial Inflammation |
Subendothelial lymphocytic infiltration
involving some, but not a majority of the portal and/or hepatic
venules |
1 |
Subendothelial infiltration involving most or
all of the portal and/or hepatic venules |
2 |
As above for 2, with moderate or severe
perivenular inflammation that extends into the perivenular
parenchyma and is associated with perivenular hepatocyte necrosis |
3 |
Total RAI Score = _/9
|
Reference
Anonymous. Banff Schema for Grading Liver
Allograft Rejection: An International Consensus Document. Hepatology
1997;25(3):658-63.
|