A Revision of the 1990 Working Formulation
for the Classification of Pulmonary Allograft Rejection:
Lung Rejection Study Group (LRSG)


Samuel A. Yousem, M.D., Chairmana, Gerald J. Berry, M.D.b, Philip T. Cagle, M.D.c, Dean Chamberlain, M.D., FRCP(C)d, Aliya N. Husain, M.D.e, Ralph H. Hruban, M.D.f, Alberto Marchevsky, M.D.g, N. Paul Ohori, M.D.a, Jon Ritter, M.D.h, Susan Stewart, MRC Path j, Henry D. Tazelaar, M.D.k

From the Departments of Pathology, Montefiore University Hospital, University of Pittsburgh Medical Center, Pittsburgh, PAa ; Stanford University Medical Center, Stanford, CAb; Baylor College of Medicine, Houston, TXc; Toronto General Hospital, Toronto, Ontario, Canadad; Loyola University Medical Center, Chicago, ILe ; The Johns Hopkins Hospital, Baltimore, MDf; Cedar Sinai Medical Center, Los Angeles, CAg; Barnes Hospital, Washington University School of Medicine, St. Louis, MOh; Papworth Hospital NHS Trust, Cambridge, Englandj; Mayo Clinic, Rochester, MNk


ABSTRACT

In 1990, an international grading scheme for the grading of lung allograft rejection was instituted. The use of this classification has resulted in a uniformity of grading which has allowed inter-institutional collaborations and communication unique in allograft monitoring. In 1995 an expanded group of international pathologists convened and revised the original proposal. This manuscript summarizes the updated classification for lung allograft rejection. In brief, acute rejection is based on perivascular and interstitial mononuclear infiltrates. Each grade of acute rejection should mention the presence of coexistent airway inflammation whose intensity is also graded. Chronic rejection is divided into airway fibrosis or bronchiolitis obliterans -- active or inactive -- and vascular fibrosis -- accelerated arterial or venous sclerosis.

J. Heart Lung Transplantation 1996;15:1-15


Key words: lung, rejection, allograft, bronchiolitis obliterans, graft atherosclerosis, acute rejection, chronic rejection
Running head: Standardized Nomenclature in Lung Rejection, 1995
Acknowledgments: The authors acknowledge the exceptional role of Mark Wick, M.D. as a consultant to this effort, Christel Lollo for secretarial efforts and Linda Shab and Jeff Levis for photographic assistance.
Reprint Requests: Samuel A. Yousem, M.D.,
Department of Pathology- NW 625,
Montefiore University Hospital,
University of Pittsburgh Medical Center,
200 Lothrop Street,
Pittsburgh, PA 15213-2582


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