Acute Rejection Grading

Rejection Rejection Rejection Rejection Rejection Rejection Rejection Rejection

Moderate and Severe Acute Rejection

In cardiac transplantation, mild acute rejection (IHLTS grades 1A and 1B) is often not treated with increased immunosuppression. In contrast, multifocal moderate or severe acute rejection (IHLTS grade 3 and 4) are almost uniformly treated with augmented immunosuppression. Therefore, the histopathological distinction between mild and moderate is practically important for patient management.

The most useful histopathological features used to distinguish between mild and aggressive multifocal rejection are the severity of the inflammation, myocyte necrosis and the presence of segmented leukocytes (especially eosinophils). As the rejection reaction worsens, one can see focal areas of myocyte necrosis, edema, interstitial hemorrhage and occasionally a frank vasculitis.

Last Modified: Mon Aug 24 8:00:00 EDT 2009