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      Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection.

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          Abstract

          In 1990, an international grading system for cardiac allograft biopsies was adopted by the International Society for Heart Transplantation. This system has served the heart transplant community well, facilitating communication between transplant centers, especially with regard to patient management and research. In 2004, under the direction of the International Society for Heart and Lung Transplantation (ISHLT), a multidisciplinary review of the cardiac biopsy grading system was undertaken to address challenges and inconsistencies in its use and to address recent advances in the knowledge of antibody-mediated rejection. This article summarizes the revised consensus classification for cardiac allograft rejection. In brief, the revised (R) categories of cellular rejection are as follows: Grade 0 R--no rejection (no change from 1990); Grade 1 R--mild rejection (1990 Grades 1A, 1B and 2); Grade 2 R--moderate rejection (1990 Grade 3A); and Grade 3 R--severe rejection (1990 Grades 3B and 4). Because the histologic sub-types of Quilty A and Quilty B have never been shown to have clinical significance, the "A" and "B" designations have been eliminated. Recommendations are also made for the histologic recognition and immunohistologic investigation of acute antibody-mediated rejection (AMR) with the expectation that greater standardization of the assessment of this controversial entity will clarify its clinical significance. Technical considerations in biopsy processing are also addressed. This consensus revision of the Working Formulation was approved by the ISHLT Board of Directors in December 2004.

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          Author and article information

          Journal
          J Heart Lung Transplant
          The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
          Elsevier BV
          1557-3117
          1053-2498
          Nov 2005
          : 24
          : 11
          Affiliations
          [1 ] International Society for Heart and Lung Transplantation, Addison, Texas, USA. susan.stewart@papworth.nhs.uk
          Article
          S1053-2498(05)00203-2
          10.1016/j.healun.2005.03.019
          16297770
          7ff96df6-dc21-40ae-a200-71292f193686
          History

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