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Volume 42, Issue 1, Pages 47-53 (January 2010)


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International Grading Scheme for Acute Cellular Rejection in Small-Bowel Transplantation: Single-Center Experience

P. RuizabCorresponding Author Informationemail address, H. Takahashia, V. Delacruzb, E. Islanda, G. Selvaggia, S. Nishidaa, J. Moona, L. Smithc, T. Asaokaa, D. Levia, A. Tekina, A.G. Tzakisa

Abstract 

A standardized grading scheme for the assessment of acute cellular rejection (ACR) in small-intestine transplantation was proposed in 2003 at the Eighth International Small Intestinal Transplantation Symposium. We have implemented the current grading scheme for ACR in small-bowel transplantation since October 2003. The pathologic diagnoses of those small-intestine biopsy samples, including ACR grade and other supplementary findings were evaluated. A total of 3484 small intestine biopsy samples from 155 patients were available for evaluation in this study. Frequency of grades 0, indeterminate, 1, 2, and 3 acute cellular rejection was 33.9%, 49.1%, 12.6%, 3.7%, and 0.8%, respectively. Duration of ACR episode strongly correlated with grade of ACR episode (P < .001). Other supplementary findings included acute vascular rejection component, 2.2%; increase in lymphoplasmacytic infiltrate in lamina propria, 15.7%; mucosal fibrosis, 0.4%; and regenerative changes, 0.3%. Our data substantiate that this grading system is reliable and useful for clinical decision making in bowel transplantation. We suggest that an assessment and quantification of supplementary findings be considered a component of the International Pathology Grading Scheme.

a Department of Surgery, University of Miami School of Medicine, Miami, Florida

b Department of Pathology, University of Miami School of Medicine, Miami, Florida

c Department of Pediatrics, University of Miami School of Medicine, Miami, Florida

Corresponding Author InformationAddress reprint requests to Philip Ruiz, MD, PhD, Department of Surgery, University of Miami School of Medicine, Rosensteil Medical Sciences Building, Transplant Laboratories, 1600 NW 10th Ave, Suite 8150, Miami, FL 33136

PII: S0041-1345(09)01782-5

doi:10.1016/j.transproceed.2009.12.026


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