TY - JOUR
T1 - Reliability for grading acute rejection and airway inflammation after lung transplantation
AU - Chakinala, Murali M.
AU - Ritter, Jon
AU - Gage, Brian F.
AU - Aloush, Aviva A.
AU - Hachem, Ramsey H.
AU - Lynch, John P.
AU - Patterson, G. Alexander
AU - Trulock, Elbert P.
N1 - Funding Information:
We acknowledge the contributions of the lung transplant coordinators (Jan Fassler, Carol Miller, Laura Roldan, and Kate Sander) and bronchoscopy technicians (Michael Henderson, Karen McBride, and David Misselhorn) who collected and maintained the information that permitted this analysis. We acknowledge Dr Felix Fernandez, who presented this data at the April 2003 International Society for Heart and Lung Transplant meeting in Vienna, Austria. Supported by NIH T32 HL007317 (to MMC).
PY - 2005/6
Y1 - 2005/6
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=20444421849&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2004.04.002
DO - 10.1016/j.healun.2004.04.002
M3 - Article
C2 - 15949723
AN - SCOPUS:20444421849
SN - 1053-2498
VL - 24
SP - 652
EP - 657
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 6
ER -