Abstract
BACKGROUND: There has been no large evaluation of the ISHLT 2004 acute cellular rejection grading scheme for heart graft endomyocardial biopsy specimens (EMBs). METHODS: We evaluated agreement within the CARGO II pathology panel and between the panel (acting by majority) and the collaborating centers (treated as a single entity), regarding the ISHLT grades of 937 EMBs (with all grades ≥2R merged because of small numbers). RESULTS: Overall all-grade agreement was almost 71% both within the panel and between the panel and the collaborating centers but, in both cases, was largely because of agreement on grade 0: for the average pair of pathologists, fewer than a third of the EMBs assigned grade ≥2R by at least one were assigned this grade by both. CONCLUSION: The 2004 revision has done little to improve agreement on the higher ISHLT grades. An EMB grade ≥2R is not by itself sufficient as a basis for clinical decisions or as a research criterion. Steps should be taken toward greater uniformity in EMB grading, and efforts should be made to replace the ISHLT classification with diagnostic criteria-EMB based or otherwise-that correspond better with the pathophysiology of the transplanted heart.
Original language | English (US) |
---|---|
Pages (from-to) | 1172-1177 |
Number of pages | 6 |
Journal | Transplantation |
Volume | 94 |
Issue number | 11 |
DOIs | |
State | Published - Dec 15 2012 |
Keywords
- Biopsy
- Gene expression
- Heart transplantation
- Pathology
- Rejection
ASJC Scopus subject areas
- Transplantation