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Allograft Liver Template
(2 H & E)
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1. Histological Evaluation
1.1 Are there more than four portal tracts?( ) Yes( ) No
1.2 Is specimen otherwise considered adequate?( ) Yes( ) No
2. Portal Tract (check one under each category)
2.1 Overall inflammation intensity( ) None( ) Mild( ) Mod( ) Severe
2.2 Bile duct inflammation/damage( ) Yes( ) No
2.3 Granuloma(s)( ) Yes( ) No
2.4 Bile duct loss( ) Yes( ) No
2.5 Bile duct/cholangiolar proliferation (any tract)( ) Yes( ) No
2.6 Bile duct atrophy/pyknosis (majority of tracts)( ) Yes( ) No
2.7 Florid duct lesion( ) Yes( ) No
2.8 Fibro-obliterative duct lesion( ) Yes( ) No
3. Inflammatory or necrotizing arteritis( ) Yes( ) No
4. Obliterative arteriopathy( ) Yes( ) No
5. Subendothelial inflammation
5.1 Severity( ) None( ) Mild( ) Mod( ) Severe
5.2 Location( ) N/A( ) Portal( ) Central( ) Both
6. Fibrosis (check one under each category)
6.1 Portal( ) None( ) Mild( ) Mod( ) Severe (bridging)
6.2 Central( ) None( ) Mild( ) Mod( ) Severe (bridging)
6.3 Architectural distortion( ) None( ) Mild( ) Mod( ) Severe
7. Lobular disarray/ballooning( ) None( ) Mild( ) Mod( ) Severe
8. Necrosis (check one under each category)
8.1 Piecemeal or bridging( ) None( ) Mild( ) Mod( ) Severe
8.2 Infarct (ischemia)( ) Yes( ) No
8.3 Other necrosis( ) Yes( ) No
8.4 Central lobular( ) Yes( ) No
9. Cholestasis( ) Yes( ) No
10. Fat( ) None( ) Mild( ) Mod( ) Severe
10.1 Type( ) Micro( ) Macro( ) Mixed( ) N/A
11. Lobular inflammation (check one under each category)
11.1 Severity( ) None( ) Mild( ) Mod( ) Severe
11.2 Location( ) N/A( ) Perivenular( ) Panlobular( ) Random/Focal
11.3 Granulomatous( ) Yes( ) No
12. Rejection Activity IndexRangeScore
12.1 Portal inflammation(0-3)( )
12.2 Bile duct inflammation/damage(0-3)( )
12.3 Venous endothelial inflammation(0-3)( )
12.4 Total(RAI = __/9)
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Last Modified: Thu Jun 18 10:14:08 EDT 2009