title: Concordance among pathologists in the second Cardiac Allograft Rejection Gene Expression Observational Study (CARGO II).
abstract: BACKGROUND
  There has been no large evaluation of the ISHLT 2004 acute cellular rejection grading scheme for heart graft endomyocardial biopsy specimens (EMBs).
  
  
  METHODS
  We evaluated agreement within the CARGO II pathology panel and between the panel (acting by majority) and the collaborating centers (treated as a single entity), regarding the ISHLT grades of 937 EMBs (with all grades ≥2R merged because of small numbers).
  
  
  RESULTS
  Overall all-grade agreement was almost 71% both within the panel and between the panel and the collaborating centers but, in both cases, was largely because of agreement on grade 0: for the average pair of pathologists, fewer than a third of the EMBs assigned grade ≥2R by at least one were assigned this grade by both.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Hospital Universitario A Coruña, La Coruña, Spain. Marisa.Crespo.Leiro@sergas.es
authors.forename: Maria G
authors.initials: MG
authors.lastname: Crespo-Leiro
authors.forename: Andreas
authors.initials: A
authors.lastname: Zuckermann
authors.forename: Christoph
authors.initials: C
authors.lastname: Bara
authors.forename: Paul
authors.initials: P
authors.lastname: Mohacsi
authors.forename: Uwe
authors.initials: U
authors.lastname: Schulz
authors.forename: Andrew
authors.initials: A
authors.lastname: Boyle
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Ross
authors.forename: Jayan
authors.initials: J
authors.lastname: Parameshwar
authors.forename: Michael
authors.initials: M
authors.lastname: Zakliczyński
authors.forename: Roberto
authors.initials: R
authors.lastname: Fiocchi
authors.forename: Joerg
authors.initials: J
authors.lastname: Stypmann
authors.forename: Daniel
authors.initials: D
authors.lastname: Hoefer
authors.forename: Hans
authors.initials: H
authors.lastname: Lehmkuhl
authors.forename: Mario C
authors.initials: MC
authors.lastname: Deng
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Gerald
authors.initials: G
authors.lastname: Berry
authors.forename: Charles C
authors.initials: CC
authors.lastname: Marboe
authors.forename: Susan
authors.initials: S
authors.lastname: Stewart
authors.forename: Henry D
authors.initials: HD
authors.lastname: Tazelaar
authors.forename: Helen M
authors.initials: HM
authors.lastname: Baron
authors.forename: Ian-Charles
authors.initials: IC
authors.lastname: Coleman
authors.forename: Johan
authors.initials: J
authors.lastname: Vanhaecke
mesh_terms: D001706:Biopsy / Q000592:standards; D004396:Coloring Agents; D004801:Eosine Yellowish-(YS); D005060:Europe; D005786:Gene Expression Regulation; D006084:Graft Rejection / Q000235:genetics* / Q000276:immunology / Q000473:pathology*; D016027:Heart Transplantation / Q000009:adverse effects*; D006416:Hematoxylin; D006801:Humans; D015588:Observer Variation; D010338:Pathology, Clinical / Q000592:standards*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013194:Staining and Labeling / Q000592:standards; D014481:United States
chemical_list: D004396:Coloring Agents; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin