|
Nomenclature and Grading of Liver Allograft Rejection (NIDDK-LTD)
|
|
Acute Rejection* |
| Grade |
Histopathological Findings |
| A0 (None) |
No rejection |
| A1 (Mild) |
Rejection infiltrate in some, but not most,
of the triads, confined within the portal spaces |
| A2 (Moderate) |
Rejection infiltrate involving most or all
of the triads, with or without spillover into lobule. No evidence
of centrilobular hepatocyte necrosis, or dropout |
| A3 (Severe) |
Infiltrate in some or all of the triads, with
or without spillover into the lobule, with or without inflammatory cell
linkage of the triads, associated with moderate-severe lobular
inflammation and lobular necrosis and dropout |
|
*
The diagnosis of acute rejection is based on the presence of at least
two of the following three findings: 1) predominantly mononuclear but
mixed portal inflammation; 2) bile duct inflammation/damage; and 3)
subendothelial localization of mononuclear cells in the portal or
central veins. Thereafter, the severity of rejection was graded on
the above findings.
|
|
Chronic (Ductopenic) Rejection§ |
| Grade |
Histopathological Findings |
| B1 (Early or Mild) |
Bile duct loss, without centrilobular
cholestatis, perivenular sclerosis, hepatocyte ballooning or
necrosis and dropout |
| B2 (Intermediate/moderate) |
Bile duct loss, with one of the following
four findings: centrilobular cholestasis, perivenular sclerosis,
hepatocellular ballooning, necrosis and dropout |
| B3 (Late or severe) |
Bile duct loss, with at least two of the
following four findings:
centrilobular cholestasis, perivenular sclerosis,
hepatocellular ballooning, centrilobular necrosis and dropout |
|
§
Bile duct loss in > 50% of triads must be present for the
diagnosis.
|
|
Reference
Demetris AJ, et al. Reliability and Predictive Value of
the National Institute of Diabetes and Digestive and Kidney Diseases
Liver Transplantation Database: Nomenclature and Grading System for
Cellular Rejection of Liver Allografts.
Hepatology 1995;21(2):408-16.
|
