Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection
Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection
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DOI：
10.1016/j.healun.2005.03.019
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发表时间：
2005-11-01
影响因子：
8.9
通讯作者：
Billingham, ME
中科院分区：
文献类型：
--
作者：
Stewart, S;Winters, GL;Billingham, ME
1990年，国际心脏移植学会采用了一种心脏同种异体移植活检的国际分级系统。该系统为心脏移植社区提供了很好的服务，促进了移植中心之间的沟通，尤其是在患者管理和研究方面。在2004年，在国际心脏和肺部移植学会（ISHLT）的指导下，对心脏活检分级系统进行了多学科审查，以解决其使用方面的挑战和不一致之处，并解决抗体介导的抗体介导的知识的最新进展拒绝。本文总结了对心脏同种异体拒绝的经修订的共识分类。简而言之，细胞排斥的修订（R）类别如下：0级R-NO拒绝（与1990年无变化）； 1年级R-MILD拒绝（1990年级1A，1B和2年级）； 2年级R-中等排斥（1990年3A级）;和3年级R-Cevere拒绝（1990年3B和4年级）。由于Quilty A和Quilty B的组织学子类型从未被证明具有临床意义，因此已经消除了“ A”和“ B”名称。还为急性抗体介导的排斥反应（AMR）的组织学识别和免疫组织学研究提出了建议，并期望对该有争议的实体评估的更高标准化将阐明其临床意义。还解决了活检处理中的技术考虑因素。这项对工作配方的共识修订于2004年12月得到ISHLT董事会的批准。
In 1990, an international grading system for cardiac allograft biopsies was adopted by the international Society for Heart Transplantation. This system has served the heart transplant community well, facilitating communication between transplant centers, especially with regard to patient management and research. In 2004, under the direction of the International Society for Heart and Lung Transplantation (ISHLT), a multidisciplinary review of the cardiac biopsy grading system was undertaken to address challenges and inconsistencies in its use and to address recent advances in the knowledge of antibody-mediated rejection. This article summarizes the revised consensus classification for cardiac allograft rejection. In brief, the revised (R) categories of cellular rejection are as follows: Grade 0 R-no rejection (no change from 1990); Grade 1 R-mild rejection (1990 Grades 1A, 1B and 2); Grade 2 R-moderate rejection (1990 Grade 3A); and Grade 3 R-severe rejection (1990 Grades 3B and 4). Because the histologic sub-types of Quilty A and Quilty B have never been shown to have clinical significance, the "A" and "B" designations have been eliminated. Recommendations are also made for the histologic recognition and immunohistologic investigation of acute antibody-mediated rejection (AMR) with the expectation that greater standardization of the assessment of this controversial entity will clarify its clinical significance. Technical considerations in biopsy processing are also addressed. This consensus revision of the Working Formulation was approved by the ISHLT Board of Directors in December 2004.