Email updates

Keep up to date with the latest news and content from Diagnostic Pathology and BioMed Central.

Open Access Highly Accessed Open Badges Research

T cell immunohistochemistry refines lung transplant acute rejection diagnosis and grading

Lin Cheng1, Haizhou Guo23, Xinwei Qiao3, Quan Liu4, Jun Nie3, Jinsong Li3, Jianjun Wang3 and Ke Jiang3*

Author Affiliations

1 Department of Anesthesiology, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

2 Department of Thoracic Surgery, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China

3 Department of Thoracic Surgery, Union hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1277 Jiefang Avenue, Wuhan 430022, Hubei Province, P. R. China

4 Department of Cardiovascular Surgery, Second Affiliated Hospital, Harbin Medical University, Harbin, China

For all author emails, please log on.

Diagnostic Pathology 2013, 8:168  doi:10.1186/1746-1596-8-168

Published: 14 October 2013



Lung transplant volume has been increasing. However, inaccurate and uncertain diagnosis for lung transplant rejection hurdles long-term outcome due to, in part, interobserver variability in rejection grading. Therefore, a more reliable method to facilitate diagnosing and grading rejection is warranted.


Rat lung grafts were harvested on day 3, 7, 14 and 28 post transplant for histological and immunohistochemical assessment. No immunosuppressive treatment was administered. We explored the value of interstitial T lymphocytes quantification by immunohistochemistry and compared the role of T cell immunohistochemistry with H&E staining in diagnosing and grading lung transplant rejection.


Typical acute rejection from grade A1 to A4 was found. Rejection severity was heterogeneously distributed in one-third transplanted lungs (14/40): lesions in apex and center were more augmented than in the base and periphery of the grafts, respectively. Immunohistochemistry showed profound difference in T lymphocyte infiltration among grade A1 to A4 rejections. The coincidence rate of H&E and immunohistochemistry was 77.5%. The amount of interstitial T lymphocyte infiltration increased gradually with the upgrading of rejection. The statistical analysis demonstrated that the difference in the amount of interstitial T lymphocytes between grade A2 and A3 was not obvious. However, T lymphocytes in lung tissue of grade A4 were significantly more abundant than in other grades.


Rejection severity was heterogeneously distributed within lung grafts. Immunohistochemistry improves the sensitivity and specificity of rejection diagnosis, and interstitial T lymphocyte quantitation has potential value in diagnosing and monitoring lung allograft rejection.

Virtual slides

The virtual slides for this article can be found here: webcite.

Lung transplantation; Immunohistochemistry; T lymphocyte