Standardized Cardiac Biopsy Grading

Standardized Cardiac Biopsy Grading
Grade Histopathological Findings

0 No rejection

1 (1A or 1B) A = Focal (perivascular or interstitial) infiltrate without necrosis

B = Diffuse but sparse infiltrate without necrosis

2 One focus only with aggressive infiltration and/or focal myocyte damage

3 (3A or 3B) A = Multifocal aggressive infiltrates and/or myocyte damage

B = Diffuse inflammatory process with necrosis

4 Diffuse aggressive polymorphous ± infiltrate ± edema, ± hemorrhage, ± vasculitis, with necrosis

Additional Required Information*

Biopsy less than 4 pieces

Humoral rejection (positive IF, vasculitis, or severe edema in absence of cellular infiltrate

"Quilty" effect (Type A or Type B)
A = No myocyte encroachment

B = With myocyte encroachment

Ischemia
A = Up to 3 weeks posttransplant

B = Late ischemia

Infection present - biopsy therefore uninterpretable

Lymphoproliferative disorder

Other (specify)

* Must be added to biopsy report if present

Reference Billingham ME, et al. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: heart rejection study group. J Heart Trans 1990;9(6):587-93.

Standardized Cardiac Biopsy Grading
Grade	Histopathological Findings
0	No rejection
1 (1A or 1B)	A = Focal (perivascular or interstitial) infiltrate without necrosis
1 (1A or 1B)	B = Diffuse but sparse infiltrate without necrosis
2	One focus only with aggressive infiltration and/or focal myocyte damage
3 (3A or 3B)	A = Multifocal aggressive infiltrates and/or myocyte damage
3 (3A or 3B)	B = Diffuse inflammatory process with necrosis
4	Diffuse aggressive polymorphous ± infiltrate ± edema, ± hemorrhage, ± vasculitis, with necrosis
Additional Required Information*
Biopsy less than 4 pieces
Humoral rejection (positive IF, vasculitis, or severe edema in absence of cellular infiltrate
"Quilty" effect (Type A or Type B)	A = No myocyte encroachment
"Quilty" effect (Type A or Type B)	B = With myocyte encroachment
Ischemia	A = Up to 3 weeks posttransplant
Ischemia	B = Late ischemia
Infection present - biopsy therefore uninterpretable
Lymphoproliferative disorder
Other (specify)
* Must be added to biopsy report if present
Reference Billingham ME, et al. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: heart rejection study group. J Heart Trans 1990;9(6):587-93.