November 13, 2012Transplantation182 citationsOpen Access

Concordance Among Pathologists in the Second Cardiac Allograft Rejection Gene Expression Observational Study (CARGO II)

MCMaría G. Crespo‐LeiroHeart Failure / Cardiomyopathy AZAndreas ZuckermannIsrael Institute for Biological Research CBChristoph BaraHeart Failure & Transplant

Structured PICO

Does the 2004 ISHLT revision improve concordance among pathologists for grading cardiac allograft rejection?

Population

Cardiac allograft recipients in the Second Cardiac Allograft Rejection Gene Expression Observational Study (CARGO II)

Intervention

Endomyocardial biopsy (EMB) grading using the 2004 ISHLT classification

Outcome

Concordance among pathologists on ISHLT grades

The 2004 ISHLT grading system for endomyocardial biopsies shows poor inter-pathologist agreement for higher grades, suggesting it should not be used in isolation for clinical decisions.

Abstract

The 2004 revision has done little to improve agreement on the higher ISHLT grades. An EMB grade ≥2R is not by itself sufficient as a basis for clinical decisions or as a research criterion. Steps should be taken toward greater uniformity in EMB grading, and efforts should be made to replace the ISHLT classification with diagnostic criteria--EMB based or otherwise--that correspond better with the pathophysiology of the transplanted heart.

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