Can automatic image analysis replace the pathologist in cardiac allograft rejection diagnosis?

European Heart Journal, Volume 42, Issue 24, 21 June 2021, Pages 2370–2372,  Published: 17 May 2021

For more than 40 years, the monitoring of acute cardiac allograft rejection has been done by serial invasive endomyocardial biopsies (EMBs) that are assessed by specialized cardiovascular pathologists through basic histology. This method started with the development of a bioptome by Philip Caves and Margaret Billingham in 1973 describing the first histological grading system.1 In 1990, a standardized international grading system for the histopathological diagnosis of acute rejection in EMB was adopted by the International Society for Heart and Lung Transplantation (ISHLT)2 and improved in later years. In this grading system, diagnostic criteria are provided for the two phenotypes of acute rejection: acute cellular rejection (ACR) and antibody-mediated rejection (AMR). Despite this effort to arrive at standardization, it is recognized that the reliability of EMB interpretation by pathologists is limited by high interobserver variability in discriminating true acute rejection from non-rejection effects, while the invasive nature of this method is another disadvantage.

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