Classification of acute cellular rejection in pancreas allograft

Acute cellular rejection	Histopathology
Borderline	Active septal inflammation (activated lymphocytes ± eosinophils)
Grade I (mild)	Active septal inflammation with one of the following: Venulitis (subendothelial inflammatory cells in septal veins) Ductitis (infiltration and damage of ductal epithelium) Inflammation of nerve branches (rarely seen at the microscope) Focal acinar inflammation (1 to 2 inflammatory foci* per lobule with absent or minimal acinar cell injury)
Grade II (moderate)	Multifocal acinar inflammation (≥3 inflammatory foci per lobule, but not diffuse, with single cell injury/dropout), and/or Minimal intimal arteritis (<25% luminal compromise)
Grade III (severe)	Diffuse acinar inflammation with multicell injury, and/or Moderate to severe intimal arteritis (>25% luminal compromise with evidence of intimal injury), and/or Transmural/necrotizing arteritis

Histological grading of acute cellular rejection.

* A focus acinar inflammation is a collection of ≥10 lymphocytes/eosinophils within an acinar area.

Adapted from: Drachenberg CB, Torrealba JR, Nankivell BJ, et al. Guidelines for the diagnosis of antibody-mediated rejection in pancreas allografts-updated Banff grading schema. Am J Transplant 2011; 11:1792. http://onlinelibrary.wiley.com/wol1/doi/10.1111/j.1600-6143.2011.03670.x/abstract. Copyright © 2011 The American Society of Transplantation and the American Society of Transplant Surgeons. Reproduced with permission of John Wiley & Sons Inc. This image has been provided by or is owned by Wiley. Further permission is needed before it can be downloaded to PowerPoint, printed, shared or emailed. Please contact Wiley's permissions department either via email: [email protected] or use the RightsLink service by clicking on the 'Request Permission' link accompanying this article on Wiley Online Library (http://onlinelibrary.wiley.com).

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Classification of acute cellular rejection in pancreas allograft