LUNG TRANSPLANT REJECTION

 

Classification of rejection

  1. Acute rejection: perivascular inflammation
    1. Grade 0 none
    2. Grade 1 minimal: infrequent perivascular infiltrates
    3. Grade 2 mild: frequent perivascular infiltrates
    4. Grade 3 moderate: dense perivascular infiltrates extending into alveolar space
    5. Grade 4 severe: diffuse perivascular, interstitial, and alveolar infiltrates; pneumocyte damage; and parenchymal necrosis, infarction, pr necrotizing vasculitis
  2. Airway inflammation: lymphocyctic bronchitis/bronchiolitis documented with acute rejection
    1. Grade 0 none
    2. Grade 1 minimal
    3. Grade 2 mild
    4. Grade 3 moderate
    5. Grade 4 severe
  3. Chronic airway rejection; bronchiolitis obliterans, active or inactive
  4. Chronic vascular rejection; accelerated graft vascular sclerosis

 

Staging of Bronchiolitis Obliterans Syndrome

Stage

Severity

FEV1(%baseline)

0

No symptoms

>80%

1

Mild

66-80%

2

Moderate

51-65%

3

Severe

<51%