Banff grading system for liver allograft rejection

Parameters

 portal inflammation

• lymphocytic infiltrate in some portal spaces : 1
• lymphocytic infiltrate with some activated lymphocytes, neutrophilic and eosinophilic polymorphonuclear in most portal spaces: 2
• numerous activated lymphocytes in a dense infiltrate in most portal spaces. Periportal inflammatory lesions.

 Biliary tract lesions

• slight bile duct alterations with minimal inflammatory reaction
• inflammatory infiltrate of most of bile ducts with epithelial lesions
• alterations of all bile ducts. Focal bile duct dysruption.

 endothelitis

• subendothelial lymphocytic infiltration of some portal and/or centrilobular veins
• subendothelial lymphocytic infiltration of most portal and/or centrilobular veins
• association of previous lesions with centrilobular inflammation and necrosis

RAI (Rejection activity index)

 no rejection : 0-2
 indeterminate rejection : 3
 slight rejection : 4-5
 moderate rejection : 6-7
 severe rejection : 8-9

References

 Banff Working Group, Demetris AJ, Adeyi O, Bellamy CO, Clouston A, Charlotte F, et al. Liver biopsy interpretation for causes of late liver allograft dysfunction. Hepatology 2006; 44: 489-501.

 International Panel. Banff schema for grading liver allograft rejection: an international consensus document. Hepatology 1997; 25: 658-663.