title: Reliability for grading acute rejection and airway inflammation after lung transplantation.
abstract: BACKGROUND
  The Lung Rejection Study Group (LRSG) created a scheme for grading acute allograft rejection in 1990 and then revised it in 1996, but virtually no studies have evaluated the reliability of this formulation. This investigation assessed the reliability of the current LRSG system by determining inter- and intrareader agreement for grading transbronchial biopsy samples from lung transplant recipients.
  
  
  METHODS
  Biopsy samples from a cohort of 204 recipients were reviewed and classified by a single pathologist who was blinded to original interpretations. The "A" and "B" rejection grades from this contemporary review were compared with original grades by the kappa statistic.
  
  
  RESULTS
  For "A" grading, weighted kappa was 0.65 (95% confidence interval [CI] 0.60-0.70) for interreader agreement (n = 529 specimens) and 0.65 (95% CI 0.53-0.76) for intrareader agreement (n = 97 specimens). For "B" grading, weighted kappa was 0.26 (95% CI 0.14-0.39) for interreader agreement (n = 164 specimens) and 0.33 (95% CI 0.15-0.51) for intrareader agreement (n = 58 specimens).
  
  
  CONCLUSIONS
  On the basis of the analysis of the LRSG scheme, "A" grades exhibit very good reliability, but "B" grades have only fair reliability, and steps to improve this shortcoming should be taken.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Missouri 63110, USA. chakinalam@wustl.edu
authors.forename: Murali M
authors.initials: MM
authors.lastname: Chakinala
authors.forename: Jon
authors.initials: J
authors.lastname: Ritter
authors.forename: Brian F
authors.initials: BF
authors.lastname: Gage
authors.forename: Aviva A
authors.initials: AA
authors.lastname: Aloush
authors.forename: Ramsey H
authors.initials: RH
authors.lastname: Hachem
authors.forename: John P
authors.initials: JP
authors.lastname: Lynch
authors.forename: G Alexander
authors.initials: GA
authors.lastname: Patterson
authors.forename: Elbert P
authors.initials: EP
authors.lastname: Trulock
mesh_terms: D000208:Acute Disease; D000328:Adult; D001991:Bronchitis / Q000209:etiology / Q000473:pathology*; D001999:Bronchoscopy; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology*; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012720:Severity of Illness Index