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Grading of Acute Pancreas Allograft Rejection
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| Grade |
Histopathology |
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Grade 0 (NORMAL)
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Unremarkable pancreatic parenchyma without inflammatory infiltrates
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Grade I (INFLAMMATION OF UNDETERMINED SIGNIFICANCE)
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Sparse, purely septal mononuclear inflammatory infiltrates. No venous endotheliitis or acinar involvement identified
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Grade II (MINIMAL)
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Purely septal inflammation with venous endotheliitis (attachment of lymphocytes to the endothelium with associated endothelial damage and lifting of the endothelium from the basement membrane).
In the absence of venous endotheliitis a constellation of at least 3 of the following 4 histologic features:
- Septal inflammatory infiltrates composed of a mixed population of small and large ("activated") lymphocytes
- Eosinophils
- Acinar inflammation in rare (up to 2) foci
- Ductal inflammation (permeation of inflammatory cells through the ductal basement membrane)
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Grade III (MILD)
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Septal inflammatory infiltrates composed of a mixed population of small and large ("activated") lymphocytes with associated acinar inflammation in multiple (3 or more) foci. Eosinophils, venous endotheliitis, ductal inflammation and evidence of acinar single cell injury may be seen depending on sampling. The latter is manifested as cellular drop-out (apoptosis-pyknotic cell death), or necrosis (oncotic cell death)
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Grade IV (MODERATE)
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Arterial endotheliitis and/or necrotizing arteritis (vasculitis). Features described in Grade III are usually present
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Grade V (SEVERE)
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Extensive acinar lymphoid or mixed inflammatory infiltrates with multicellular focal or confluent acinar cell necrosis. Depending on sampling vascular and ductal lesions may be demonstrated
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Reference
Drachenberg CB, Papadimitriou JC,
Klassen DK, et al. Evaluation of pancreas transplant needle biopsy: reproducibility and revision of histologic grading system. Transplantation 1997;63(11):1579-1586
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