Revision of the 1996 Working Formulation for the Standardization of Nomenclature in the Diagnosis of Lung Rejection

Susan Stewart, Michael C. Fishbein, Gregory I. Snell, Gerald J. Berry, Annette Boehler, Margaret M. Burke, Alan Glanville, F. Kate Gould, Cynthia Magro, Charles C. Marboe, Keith D. McNeil, Elaine F. Reed, Nancy L. Reinsmoen, John P. Scott, Sean M. Studer, Henry D. Tazelaar, John L. Wallwork, Glen Westall, Martin R. Zamora, Adriana ZeeviSamuel A. Yousem

Research output: Contribution to journalArticle

598 Citations (Scopus)

Abstract

In 1990, an international grading scheme for the grading of pulmonary allograft rejection was adopted by the International Society for Heart and Lung Transplantation (ISHLT) and was modified in 1995 by an expanded group of pathologists. The original and revised classifications have served the lung transplant community well, facilitating communication between transplant centers with regard to both patient management and research. In 2006, under the direction of the ISHLT, a multi-disciplinary review of the biopsy grading system was undertaken to update the scheme, address inconsistencies of use, and consider the current knowledge of antibody-mediated rejection in the lung. This article summarizes the revised consensus classification of lung allograft rejection. In brief, acute rejection is based on perivascular and interstitial mononuclear infiltrates, Grade A0 (none), Grade A1 (minimal), Grade A2 (mild), Grade A3 (moderate) and Grade A4 (severe), as previously. The revised (R) categories of small airways inflammation, lymphocytic bronchiolitis, are as follows: Grade B0 (none), Grade B1R (low grade, 1996, B1 and B2), Grade B2R (high grade, 1996, B3 and B4) and BX (ungradeable). Chronic rejection, obliterative bronchiolitis (Grade C), is described as present (C1) or absent (C0), without reference to presence of inflammatory activity. Chronic vascular rejection is unchanged as Grade D. Recommendations are made for the evaluation of antibody-mediated rejection, recognizing that this is a controversial entity in the lung, less well developed and understood than in other solid-organ grafts, and with no consensus reached on diagnostic features. Differential diagnoses of acute rejection, airway inflammation and chronic rejection are described and technical considerations revisited. This consensus revision of the working formulation was approved by the ISHLT board of directors in April 2007.

Original languageEnglish (US)
Pages (from-to)1229-1242
Number of pages14
JournalJournal of Heart and Lung Transplantation
Volume26
Issue number12
DOIs
StatePublished - Dec 2007
Externally publishedYes

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Terminology
Lung
Heart-Lung Transplantation
Consensus
Bronchiolitis
Transplants
Allografts
Inflammation
Rejection (Psychology)
Antibodies
varespladib methyl
Blood Vessels
Differential Diagnosis
Communication
Biopsy
Research

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Stewart, S., Fishbein, M. C., Snell, G. I., Berry, G. J., Boehler, A., Burke, M. M., ... Yousem, S. A. (2007). Revision of the 1996 Working Formulation for the Standardization of Nomenclature in the Diagnosis of Lung Rejection. Journal of Heart and Lung Transplantation, 26(12), 1229-1242. https://doi.org/10.1016/j.healun.2007.10.017

Revision of the 1996 Working Formulation for the Standardization of Nomenclature in the Diagnosis of Lung Rejection. / Stewart, Susan; Fishbein, Michael C.; Snell, Gregory I.; Berry, Gerald J.; Boehler, Annette; Burke, Margaret M.; Glanville, Alan; Gould, F. Kate; Magro, Cynthia; Marboe, Charles C.; McNeil, Keith D.; Reed, Elaine F.; Reinsmoen, Nancy L.; Scott, John P.; Studer, Sean M.; Tazelaar, Henry D.; Wallwork, John L.; Westall, Glen; Zamora, Martin R.; Zeevi, Adriana; Yousem, Samuel A.

In: Journal of Heart and Lung Transplantation, Vol. 26, No. 12, 12.2007, p. 1229-1242.

Research output: Contribution to journalArticle

Stewart, S, Fishbein, MC, Snell, GI, Berry, GJ, Boehler, A, Burke, MM, Glanville, A, Gould, FK, Magro, C, Marboe, CC, McNeil, KD, Reed, EF, Reinsmoen, NL, Scott, JP, Studer, SM, Tazelaar, HD, Wallwork, JL, Westall, G, Zamora, MR, Zeevi, A & Yousem, SA 2007, 'Revision of the 1996 Working Formulation for the Standardization of Nomenclature in the Diagnosis of Lung Rejection', Journal of Heart and Lung Transplantation, vol. 26, no. 12, pp. 1229-1242. https://doi.org/10.1016/j.healun.2007.10.017
Stewart, Susan ; Fishbein, Michael C. ; Snell, Gregory I. ; Berry, Gerald J. ; Boehler, Annette ; Burke, Margaret M. ; Glanville, Alan ; Gould, F. Kate ; Magro, Cynthia ; Marboe, Charles C. ; McNeil, Keith D. ; Reed, Elaine F. ; Reinsmoen, Nancy L. ; Scott, John P. ; Studer, Sean M. ; Tazelaar, Henry D. ; Wallwork, John L. ; Westall, Glen ; Zamora, Martin R. ; Zeevi, Adriana ; Yousem, Samuel A. / Revision of the 1996 Working Formulation for the Standardization of Nomenclature in the Diagnosis of Lung Rejection. In: Journal of Heart and Lung Transplantation. 2007 ; Vol. 26, No. 12. pp. 1229-1242.
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