Table 7.

Pathologic criteria for acute humoral rejectiona

a Cases that also meet the criteria of type 1 or 2 acute cellular rejection (Banff/CCTT) are considered to have both processes.
b Bright and diffusely positive staining for C4d in peritubular capillaries.
c Neutrophils in peritubular capillaries: on average ≥2 neutrophils per high power field in peritubular capillaries in 10 consecutive ×40 (field diameter, 0.55 mm) fields; fibrinoid necrosis in an artery: larger than an arteriole; acute tubular injury: loss of brush borders, flattened epithelium, apoptosis.
If only two of the three numbered criteria are present, the term “suspicious for AHR” is recommended (for example, when donor specific antibodies are not tested).
1.C4d deposition in peritubular capillariesb
2.At least one of the following:c
a. Neutrophils in peritubular capillaries
b. Arterial fibrinoid necrosis
c. Acute tubular injury
3.Circulating donor specific antibodies