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Rejection Activity Index

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
Marked expansion of most or all of the triads by a mixed infiltrate containing numerous blasts and cosinophils 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 increased nuclear/cytoplasmic ratio of the epithelial cells
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
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
As above for 2, with moderate or severe perivenular inflammation that extends into the perivenular parenchyma and is associated with perivenular hepatocyte necrosis

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References :

D’Antiga, L. (Ed.) Pediatric Hepatology and Liver Transplantation (Springer, 2019). https://doi.org/10.1007/978-3-319-96400-3
Demetris A, Adams D, Bellamy C et al (2000) Update of the International Banff Schema for Liver Allo- graft Rejection: working recommendations for the histopathologic staging and reporting of chronic rejection. An International Panel. Hepatology 31:792–799

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Rejection Activity Index

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