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The SAMe-TT2R2 Score

• Dr Mao and colleagues comment that the results of our analysis were “ambiguous,” and they performed a “deeper analysis” of the data. We chose a k statistic (two categories) or weighted k (three ordinal categories) as a reliability measure and evaluated each time point separately (as seen in Tables 4, 5, 8, 9, 12, 13). 1 ,2 The analysis indicated that agreement was generally higher at 6 weeks with less agreement at later time points. Dr Mao and colleagues pooled data across time points and, therefore, did not account for the time differential (Tables 1, 2). • We did not utilize the McNemar-Bowker test because it is primarily used to test marginal homogeneity, not interrater agree ment. 3 ,4 Their analyses do, however, bring out systematic differences between site and central pathologists. It should be noted, though, that by pooling over time points, the correlation of longitudinal or repeated measures data is assumed to be negligible. • Dr Mao and colleagues suggest incorporating clinical risk factors of acute rejection into the statistical analysis for determining rejection. Although this is interesting, a scoring system for acute rejection based on clinical parameters was beyond the scope of this article. Future studies should evaluate this further. • We disagree with the statement that “repeated blinded readings of one slide by the same pathologist as a reliable policy is a promising approach to decrease the interobserver disagreement.” It has clearly been shown that clinical information enhances the biopsy readings by the pathologist. The purpose of the article is to understand how we can make these readings more reliable from a clinical perspective. • Dr Mao and colleagues comment that the lung transplant rejection schema should be based upon the TNM classifi cation for non-small cell lung cancer. Although the TNM classifi ca tion system for non-small cell lung cancer is an established sys tem, it does not apply to transplant biopsies or the objective of this article. These comments are irrelevant to the current article .