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Related Experiment Video

Updated: Jun 26, 2026

Mouse Kidney Transplantation: Models of Allograft Rejection

Mouse Kidney Transplantation: Models of Allograft Rejection

Published on: October 11, 2014

Reproducibility of Rejection Grading in Uterus Transplantation: A Multicenter Study.

Verena Broecker^1,2, Mats Brännström², Hans Bösmüller³

¹Department of Clinical Pathology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.

Transplantation Direct

|September 25, 2023

Summary

Uterus transplant rejection diagnosis using cervical biopsies showed excellent intraobserver but moderate interobserver reproducibility. Adding new histological lesions may improve diagnosis, but requires consensus definitions for better grading.

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Last Updated: Jun 26, 2026

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Published on: October 11, 2014

Surgical Approach, Challenges, and Resolutions for Uterus Transplantation in Rats

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Published on: April 14, 2023

Author Spotlight: Multiplex Immunohistochemistry for Understanding Immune Regulation by Uterine NK Cells in Pregnancy

Author Spotlight: Multiplex Immunohistochemistry for Understanding Immune Regulation by Uterine NK Cells in Pregnancy

Published on: October 25, 2024

Area of Science:

Reproductive medicine
Transplantation immunology
Pathology

Background:

Diagnosis of uterus transplant rejection relies on histopathological examination of ectocervical biopsies.
Current classification focuses on stromal-epithelial interface inflammation but lacks reproducibility testing and full morphological spectrum coverage.

Purpose of the Study:

To assess the reproducibility of a proposed histopathological grading scheme for uterus transplant rejection.
To evaluate the inclusion of additional histological lesions for improved rejection diagnosis.

Main Methods:

A multicenter study involving 5 pathologists from 4 centers grading 193 cervical biopsies across two rounds.
Inclusion of perivascular stromal inflammation, venous endothelial inflammation, and apoptosis in the second grading round.
Participant questionnaires explored current biopsy handling and reporting practices.

Main Results:

Intraobserver reproducibility for rejection grading was excellent; interobserver reproducibility was moderate and did not improve.
Reproducibility for perivascular stromal inflammation was moderate, while venous endothelial inflammation and apoptosis showed unsatisfactory reproducibility.
Identified lesions were more frequent in, but not exclusive to, biopsies showing rejection patterns.

Conclusions:

The grading of rejection in cervical biopsies is reproducible and applicable across different uterus transplantation centers.
Incorporating additional histological lesions could enhance rejection diagnosis, necessitating rigorous consensus definitions for these lesions.