Abstract
Protocol surveillance endomyocardial biopsies are performed to assess for rejection and thus allow the treatment of rejection prior to symptomatic cardiac dysfunction. The biopsies are performed with decreasing frequency post-transplant, usually stopping at 1–3 years post-transplant. A standardised method of grading was introduced in 1990 under the auspices of the International Society for Heart and Lung Transplantation (ISHLT), which was simplified based on clinical outcome data in 2005. The 2005 ISHLT grading scheme is a four-grade system, differentiated from the 1990 grades by an “R”, for revised, after the grade. It ranges from grade 0R, no rejection, to 3R, severe rejection. Mild (grade 1R) rejection is characterised by a mononuclear cell infiltrate with no more than a single focus of muscle damage, moderate (grade 2R) rejection having two or more foci with muscle damage, and severe (grade 3R) rejection has extensive muscle damage with oedema and haemorrhage.
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Neil, D.A.H., Rice, A.J. (2016). Pathology of Acute Cellular Rejection. In: Leone, O., Angelini, A., Bruneval, P., Potena, L. (eds) The Pathology of Cardiac Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-46386-5_13
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DOI: https://doi.org/10.1007/978-3-319-46386-5_13
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