Lung Rejection Study Group

Revision of the 1996 Working Formulation for the Standardization of Nomenclature in the Diagnosis of Lung Rejection

CONCLUSIONS

This multidisciplinary review of the classification of lung allograft rejection has taken place more than a decade since the previous revision.2 There was continued support for retaining the previous acute rejection grades and for collapsing of the previous lymphocytic bronchiolitis (B) grades. The consensus group concluded that more detailed descriptions of the various grades and differential diagnoses, mainly in the form of additional photomicrographs, would enhance the usefulness of the 2006 revision and thereby improve reproducibility. The group also tackled the contentious issue of antibody-mediated rejection in the lung and reviewed the available literature. The consensus was that the available evidence supports the possibility of antibody-mediated rejection after lung transplantation but that more studies are required to determine which of the previously described pathologic lesions could be the histologic counterparts of this form of acute rejection.

Proposals for a standardized approach to investigating possible antibody-mediated rejection have been suggested to focus research endeavors in this difficult field. The consensus meeting again emphasized the importance of amalgamating the clinical, histologic, radiologic, immunologic and microbiologic data in a multidisciplinary setting to achieve the most accurate diagnosis for a particular patient episode. As always, the working formulation is regarded as a live document that will no doubt require further modification in the future with the advent of further molecular and other diagnostic refinements for the diagnosis and management of this complicated group of allograft recipients.

REFERENCES

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APPENDIX: Participants by Task Force

Chair of consensus meeting: Susan Stewart, FRCPath.

Histopathology

Chair: Samuel A. Yousem, MD. Participants: Gerald J. Berry, MD; Margaret M. Burke, FRCPath; Michael C. Fishbein, MD; Charles C. Marboe, MD; Henry D. Tazelaar, MD.

We also acknowledge the invaluable contribution of the following international lung transplant pathologists who answered the questionnaire on the re-evaluation of the 1996 working formulation: Philip Cagle, MD, Belinda Clarke, FRCPA, Aliya Husain, MD, David Hwang, MD, Alberto Marchevsky, MD, N. Paul Ohori, MD, Jon Ritter, MD, Dani S. Zander, MD.

Immunopathology

Chair: Michael C. Fishbein, MD. Participants: Cynthia Magro, MD, Elaine F. Reed, PhD, Nancy L. Reismoen, PhD, Adriana Zeevi, PhD.

Clinical Lung Transplantation

Chair: Gregory I. Snell, MD. Participants: Annette Boehler, MD, Alan Glanville, MD, F. Kate Gould, FRCPath, Keith D. McNeil, FRACP, John P. Scott, MD, Sean M. Studer, MD, John Wallwork, FRCS, Glen Westall, MD, Martin R. Zamora, MD.


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