Liver Transplantation

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Modified HAI Grading: Necroinflammatory Scores
Periportal or Periseptal Interface Hepatitis (piecemeal necrosis)
(A)		 Score Confluent Necrosis
(B)		 Score Focal (spotty) Lytic Necrosis, Apoptosis, and Focal Inflammation*
(C)		 Score Portal Inflammation
(D)		 Score
Absent 0 Absent 0 Absent 0 None 0
Mild (focal, few portal areas) 1 Focal confluent necrosis 1 One focus or less per 10x objective 1 Mild, some or all portal areas 1
Mild/moderate (focal, most portal areas) 2 Zone 3 necrosis in some areas 2 Two to four foci per 10x objective 2 Moderate, some or all portal areas 2
Moderate (continuous around <50% of tracts or septa) 3 Zone 3 necrosis in most areas 3 Five to ten foci per 10x objective 3 Moderate/marked, all portal areas 3
Severe (continuous around >50% of tracts or septa) 4 Zone 3 necrosis + occasional portal-central (P-C) bridging 4 More than ten foci per 10x objective 4 Marked, all portal areas 4
Zone 3 necrosis + multiple P-C bridging 5 References
  1. Ishak K, et al. Histological grading and staging of chronic hepatitis. J Hepatol 1995;22:696-699.
  2. Knodell RG, et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1981;1(5):431-5
Panacinar or multiacinar necrosis 6
Total Modified HAI = __/18
*Does not include diffuse sinusoidal infiltration by inflammatory cells.
Additional features which should be noted but not scored:
  • Bile-duct inflammation and damage
  • Lymphoid follicles
  • Steatosis, mild moderate or marked
  • Hepatocellular dysplasia, large- or small-cell
  • Adenomatous hyperplasia
  • Iron or copper overload
  • Intracellular inclusions (eg. PAS-positive globules, Mallory bodies)
Immunohistochemical findings
  • Information on viral antigens, lymphocyte subsets or other features, when available, should be recorded and may be semi-quantitatively expressed
Modified Staging: architectural changes, fibrosis and cirrhosis*
Change Score
No fibrosis 0
Fibrous expansion of some portal areas, with or without short fibrous septa 1
Fibrous expansion of most portal areas, with or without short fibrous septa 2
Fibrous expansion of most portal areas with occasional portal to portal (P-P) bridging 3
Fibrous expansion of portal areas with marked bridging [portal to portal (P-P) as well as portal to central (P-C)] 4
Marked bridging (P-P and/or P-C) with occasional nodules (incomplete cirrhosis) 5
Cirrhosis, probable or definite 6
References
  1. Ishak K, et al. Histological grading and staging of chronic hepatitis. J Hepatol 1995;22:696-699.
  2. Knodell RG, et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1981;1(5):431-5
*Additional features which should be noted but not scored: Intra-acinar fibrosis, perivenular ('chicken wire' fibrosis) and phlebosclerosis of terminal hepatic venules.

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University of Pittsburgh.

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