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Histologic rejection activity index for liver transplantation

Histologic rejection activity index for liver transplantation
Category Criteria Score
Mixed portal inflammatory infiltrate Mostly lymphocytic inflammation involving, but not noticeably expanding, a minority of the triads 1
Expansion of most of all of the triads, by a mixed infiltrate containing lymphocytes with occasional blasts, neutrophils and eosinophils 2
Marked expansion of most or all of the triads by a mixed infiltrate containing numerous blasts and eosinophils with inflammatory spillover into the periportal parenchyma 3
Bile duct epithelial inflammation and damage A minority of the ducts are cuffed and infiltrated by inflammatory cells and show only mild reactive changes such as increased nuclear:cytoplasmic ratio of the epithelial cells 1
Most or all of the ducts infiltrated by inflammatory cells. More than an occasional duct shows degenerative changes such as nuclear pleomorphism, disordered polarity and cytoplasmic vacuolization of the epithelium. 2
As above for 2, with most or all of the ducts showing degenerative changes or focal lumenal disruption 3
Venous endothelial inflammation Subendothelial lymphocytic infiltration involving some, but not a majority of the portal and/or hepatic venules 1
Subendothelial infiltration involving most or all of the portal and/or hepatic venules with or without confluent hepatocyte necrosis/dropout involving a minority of perivenular regions 2
As above for 2, with moderate or severe perivenular inflammation that extends into the perivenular parenchyma and is associated with perivenular hepatocyte necrosis 3
The sum of the scores from each category is called the rejection activity index (RAI). Rejection severity is determined by RAI values. Mild acute T-cell mediated rejection has been classified as RAI ≤4. Refer to content on defining severity of T-cell mediated rejection of the liver allograft.
Adapted from: Demetris AJ, Batta KP, Dhillon AP, et al. Hepatology 1997; 25:658.
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