Revision of the 1996 Working Formulation for the Standardization of Nomenclature in the Diagnosis of Lung Rejection

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Published 1 December 2007

Susan Stewart, FRCPath; Michael C. Fishbein, MD; Gregory I. Snell, MD; Gerald J. Berry, MD; Annette Boehler, MD; Margaret M. Burke, FRCPath; Alan Glanville, MD; F. Kate Gould, FRCPath; Cynthia Magro, MD; Charles C. Marboe, MD; Keith D. McNeil, FRACP; Elaine F. Reed, PhD; Nancy L. Reinsmoen, PhD; John P. Scott, MD; Sean M. Studer, MD; Henry D. Tazelaar, MD; John L. Wallwork, FRCS; Glen Westall, MD; Martin R. Zamora, MD; Adriana Zeevi, PhD; Samuel A. Yousem, MD

J Heart Lung Transplant 2007 Dec;26(12):1229-42

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In 1990, an international grading scheme for the grading of pulmonary allograft rejection was adopted by the International Society for Heart and Lung Transplantation (ISHLT) and was modified in 1995 by an expanded group of pathologists. The original and revised classifications have served the lung transplant community well, facilitating communication between transplant centers with regard to both patient management and research. The 1996 revision was itself widely adopted by the lung transplant community and has served it well for over a decade.

In 2006, under the direction of the ISHLT, a multi-disciplinary review of the biopsy grading system was undertaken to update the scheme, address inconsistencies of use, and consider the current knowledge of antibody-mediated rejection in the lung. This article summarizes the revised consensus classification of lung allograft rejection. The revised working formulation represents a simplification of the original classification scheme, but it also highlighted some unresolved and complex issues such as the diagnosis and significance of airway inflammation. The present study reports on the consensus of revisions to the pathologic classification and is supplemented by the consensus of lung transplant physicians and surgeons focusing on the clinical viewpoint.

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