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REJECTION ACTIVITY INDEX (RAI)

Criteria which can be used to score liver allograft biopsies with acute rejection, as defined by the World Gastroenterology Consensus Document.

Category

Criteria

Score

Portal Inflammation

Mostly lymphocytic inflammation involving, but not noticeably expanding, a minority of the triads

1

Expansion of most or all of the triads, by a mixed infiltrate containing lymphocytes with occasional blasts, neutrophils and eosinophils

2

Marked expansion of most or all of the triads by a mixed infiltrate containing numerous blasts and eosinophils with inflammatory spillover into the periportal parenchyma

3

Bile Duct Inflammation Damage

A minority of the ducts are cuffed and infiltrated by inflammatory cells and show only mild reactive changes such as increased nuclear:cytoplasmic ratio of the epithelial cells

1

Most or all of the ducts infiltrated by inflammatory cells. More than an occasional duct shows degenerative changes such as nuclear pleomorphism, disordered polarity and cytoplasmic vacuolization of the epithelium

2

As above for 2, with most or all of the ducts showing degenerative changes or focal lumenal disruption

3

Venous Endothelial Inflammation

Subendothelial lymphocytic infiltration involving some, but not a majority of the portal and/or hepatic venules

1

Subendothelial infiltration involving most or all of the portal and/or hepatic venules

2

As above for 2, with moderate or severe perivenular inflammation that extends into the perivenular parenchyma and is associated with perivenular hepatocyte necrosis

3

Total RAI Score = _/9

Reference Anonymous. Banff Schema for Grading Liver Allograft Rejection: An International Consensus Document. Hepatology 1997;25(3):658-63.