Survey of Current Practice Related to Grading of Rejection in Cardiac Transplant Recipients in North America
JJ Maleszewski, LM Kucirka, DL Segev, DV Miller, MK Halushka. Mayo Clinic, Rochester, MN; The Johns Hopkins University School of Medicine, Baltimore, MD
Background: The acceptance and implementation of the International Society for Heart and Lung Transplantation's (ISHLT) most recently adopted (2005) nomenclature for diagnosing cardiac allograft rejection is unknown.
Design: We performed an online survey of pathologists at all cardiac transplant centers in the United States and Canada to determine the range of how cardiac transplant rejection is reported. The survey consisted of a series of questions relating to center volume, rejection grading system used, and reasons for using the aforementioned grading system.
Results: Survey responses were obtained from 96 (77%) of 122 centers contacted, representing 82% of the total center volume in the United States and Canada. Among respondents, 87% reported using the ISHLT-2005 grading system, either exclusively or in combination with other grading systems. Overall, 45% of respondents use only the ISHLT-2005 grading system, 40% issue reports containing both the ISHLT-2005 and ISHLT-1990 grading systems, 12% use only the ISHLT-1990 system, and 3% use either the ISHLT-2005 or the ISHLT-1990 system in combination with an institution-specific system (such as the Billingham system or Texas Heart Institute system). Reported reasons for not utilizing the ISHLT-2005 grading system exclusively were related primarily to (1) the preference of the cardiologists and cardiac surgeons at the particular center (74%), and (2) a belief that the ISHLT-2005 grading system is not as informative as the ISHLT-1990 grading system (52%).
Conclusions: There is appreciable variability in the system used for reporting rejection among North American cardiac transplant centers. Understanding the reasons behind this variability will be crucial for the development and implementation of future cardiac allograft rejection grading systems. Interestingly, the reasons most often cited for lack of exclusive utilization of the ISHLT-2005 system were either clinician/surgeon-driven rather than pathologist-driven or were based on assumptions that have not yet been validated.
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 43, Monday Morning