Table 2.

Diagnostic criteria for acute antibody-mediated rejection (AHR) (5,9)a

1. Morphologic evidence of acute tissue injury
    acute tubular injury
    neutrophils and/or mononuclear cells in PTC and/or glomeruli and/or capillary thrombosis
    fibrinoid necrosis/intramural or transmural inflammation in arteries
2. Immunopathologic evidence for antibody action
    C4d and/or (rarely) immunoglobulin in PTC
    Ig and complement in arterial fibrinoid necrosis
3. Serologic evidence of circulating antibodies to donor HLA or other anti-donor endothelial antigen
  • a Cases that meet only two of the three numbered criteria are considered suspicious for AHR. Acute cellular rejection may also be present.