ISHLT Grade (Cardiac Acute Cellular Rejection)
The International Society for Heart and Lung Transplantation grading of acute cellular rejection in a cardiac allograft (Stewart and colleagues 2005).
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- The revised ISHLT grade
- Two or more foci of infiltrate with associated myocyte damage, with…
Result: ISHLT Grade 2R (moderate, intermediate grade).
The tool opens with these values already filled in. Replace them with your own.
What the result means
- 0R
- No rejection. Unremarkable endomyocardium, no lymphocytic infiltration. From 1990 grade 0.
- 1R
- Mild. Infiltrate with up to one focus of myocyte damage. 1990 grades 1A, 1B and 2 all collapse into this.
- 2R
- Moderate. Two or more foci of infiltrate with myocyte damage. From 1990 grade 3A only.
- 3R
- Severe. Diffuse infiltrate with multifocal myocyte damage. From 1990 grades 3B and 4.
- The trap
- 3A and 3B are adjacent in the old scheme but land in different revised grades, 2R and 3R.
- Blind spots
- Acute cellular rejection only. Blind to antibody-mediated rejection (separate pAMR scale) and to allograft vasculopathy.
What you enter
- The revised ISHLT grade.
Full field descriptions
- The revised ISHLT grade. Enter the R form only - a 1990-scheme grade or a bare number is refused with its mapping, because the two schemes reuse the same numbers [0R = Grade 0R (no rejection): No evidence of rejection: unremarkable endomyocardium with no lymphocytic infiltration. (from 1990 grade 0) 1R = Grade 1R (mild, low grade): Interstitial and/or perivascular infiltrate with up to one focus of myocyte damage. Myocardial architecture is otherwise intact. (from 1990 grades 1A, 1B, 2) 2R = Grade 2R (moderate, intermediate grade): Two or more foci of infiltrate with associated myocyte damage, with uninvolved myocardium present between the foci. (from 1990 grade 3A) 3R = Grade 3R (severe, high grade): Diffuse infiltrate with multifocal myocyte damage, with or without edema, hemorrhage, or vasculitis. A diffuse process in which distinct foci cannot be made out. (from 1990 grades 3B, 4)]
How this is calculated
Stewart S, Winters GL, Fishbein MC, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant. 2005;24(11):1710-1720. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.