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ACUTE T-CELL MEDIATED REJECTION AND RAI: 2016
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GLOBAL ASSESSMENT FOR GENERAL GRADING |
| GRADE |
DESCRIPTION |
| Indeterminate |
Portal and/or perivenular inflammation related to alloreactivity but without sufficient injury to qualify for mild acute rejection |
| Mild |
Generally mild rejection type inflammation in a minority of portal or perivenular areas; Portal inflamation mostly confined to portal spaces and no hepatocyte dropout or confluent necrosis present in perivenular areas |
| Moderate |
Rejection type inflammation expanding most or all portal tracts and/or perivenular areas; hepatocyte necrosis/confluent necrosis limited to a minority of perivenular areas |
| Severe |
Similar to moderate rejection with additional features of spillover into periportal areas and/or moderate to severe perivenular inflammation extending into hepatic parenchyma with hepatocyte necrosis/confluent necrosis involving a majority of perivenular areas |
| QUANTITATIVE SCORING FOR REJECTION ACTIVITY INDEX (RAI) |
| 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 (If eosinophils are conspicuous and accompanied by edema and prominent microvascular endothelial cell hypertrophy consider possibility of acute antibody-mediated rejection) |
2 |
| Marked expansion of most or all of the triads by
a mixed infiltrate containing 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 with or without confluent hepatocyte necrosis/dropout in a minority of perivenular regions |
2 |
| As above for 2, with moderate or severe
perivenular inflammation that extends into the perivenular
parenchyma and is associated with perivenular hepatocyte necrosis involving a majority of perivenular regions |
3 |
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Total RAI Score = _/9
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Reference:
Demetris AJ et al. 2016 Comprehensive Update of the Banff Working Group on Liver Allograft Pathology: Introduction of antibody-mediated rejection. Am J Transplant 2016;16:2816-28335.
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