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.
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.
Authors: Kevin P Daly; Jason L J Dearling; Tatsuichiro Seto; Patricia Dunning; Frederic Fahey; Alan B Packard; David M Briscoe Journal: Transplantation Date: 2015-09 Impact factor: 4.939
Authors: R C Starling; J Stehlik; D A Baran; B Armstrong; J R Stone; D Ikle; Y Morrison; N D Bridges; P Putheti; T B Strom; M Bhasin; I Guleria; A Chandraker; M Sayegh; K P Daly; D M Briscoe; P S Heeger Journal: Am J Transplant Date: 2015-08-10 Impact factor: 8.086
Authors: Iwijn De Vlaminck; Hannah A Valantine; Thomas M Snyder; Calvin Strehl; Garrett Cohen; Helen Luikart; Norma F Neff; Jennifer Okamoto; Daniel Bernstein; Dana Weisshaar; Stephen R Quake; Kiran K Khush Journal: Sci Transl Med Date: 2014-06-18 Impact factor: 17.956
Authors: Philip F Halloran; Jeff Reeve; Arezu Z Aliabadi; Martin Cadeiras; Marisa G Crespo-Leiro; Mario Deng; Eugene C Depasquale; Johannes Goekler; Xavier Jouven; Daniel H Kim; Jon Kobashigawa; Alexandre Loupy; Peter Macdonald; Luciano Potena; Andreas Zuckermann; Michael D Parkes Journal: JCI Insight Date: 2018-10-18