2016 Banff liver allograft rejection activity index
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Portal inflammation
Mostly lymphocytic inflammation involving, but not noticeably expanding, a minority of the triads
Expansion of most or all of the triads by a mixed infiltrate containing lymphocytes with occasional blasts, neutrophils, and eosinophils; consider acute antibody-mediated rejection if eosinophils are conspicuous and accompanied by edema and microvascular endothelial cell hypertrophy is prominent
Marked expansion of most or all of the triads by a mixed infiltrate containing blasts and eosinophils with inflammatory spillover into the periportal parenchyma
Bile duct inflammation damage
A minority of the ducts are cuffed and infiltrated by inflammatory cells and show only mild reactive changes, such as an increased nuclear-to-cytoplasmic ratio of the epithelial cells
Most or all of the ducts are infiltrated by inflammatory cells; more than an occasional duct shows degenerative changes such as nuclear pleomorphism, disordered polarity, and cytoplasmic vacuolization of the epithelium
As above for 2, with most or all of the ducts showing degenerative changes or focal luminal disruption
Venous endothelial inflammation
Subendothelial lymphocytic infiltration involving some, but not a majority, of the portal and/or hepatic venules
Subendothelial infiltration involving most or all of the portal and/or hepatic venules with or without confluent hepatocyte necrosis/dropout involving a minority of perivenular regions
As above for 2, with moderate or severe perivenular inflammation extending into the perivenular parenchyma and associated with perivenular hepatocyte necrosis involving a majority of perivenular regions
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