Acute Rejection Grading

Grade I: Inflammation of Undetermined Significance: This grade is characterized by sparse, mononuclear inflammation in the fibrous septa. These infiltrates are usually composed of small lymphocytes or rarely a mixture of lymphocytes and plasma cells. Eosinophils are not identified. The veins, arteries and acini are free of inflammation. Mild ductal inflammation by itself is not significant without an acinar component or venous endotheliitis.
Inflammation of undetermined significance is not uncommon in protocol biopsies obtained from patients with normal function. These findings are also seen in patients with treated (resolving/ resolved) rejection or in early rejection. Sampling variations may result in a negative biopsy in a patient with rejection. In these cases there are persistent laboratory abnormalities and a repeat biopsy will be diagnostic of rejection.

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