Table 3.

Diagnostic criteria for chronic antibody-mediated rejection (CHR) (9,41)a

  1. Histologic evidence of chronic injury (need 2 of 4)

    • arterial intimal fibrosis without elastosis

    • duplication of glomerular basement membrane

    • multilaminated PTC basement membrane

    • interstitial fibrosis with tubular atrophy

  2. Evidence for antibody action/deposition in tissue (e.g., C4d in PTC)b

  3. Serologic evidence of anti-HLA or other anti-donor antibody

  • a If only two of the numbered criteria are present, then the diagnosis is considered “suspicious” for CHR.

  • b May be patchy in distribution.