학술논문
Reproducibility of Rejection Grading in Uterus Transplantation: A Multicenter Study.
Document Type
Academic Journal
Author
Broecker V; Department of Clinical Pathology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.; Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Brännström M; Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Bösmüller H; Institute of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany.; Sticová E; Clinical and Transplant Pathology Department, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.; Malušková J; Clinical and Transplant Pathology Department, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.; Chiesa-Vottero A; Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH.; Mölne J; Department of Clinical Pathology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.; Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
Source
Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 101651609 Publication Model: eCollection Cited Medium: Print ISSN: 2373-8731 (Print) Linking ISSN: 23738731 NLM ISO Abbreviation: Transplant Direct Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2373-8731
Abstract
Background: Diagnosis of rejection after uterus transplantation is based on histopathological examination of ectocervical biopsies. Inflammation at the stromal-epithelial interface is the backbone of the histopathological classification proposed by our group in 2017. However, the reproducibility of this grading scheme has not been tested, and it is unclear whether it covers the full morphological spectrum of rejection.
Methods: We present a multicenter study in which 5 pathologists from 4 uterus transplantation centers performed 2 rounds of grading on 145 and 48 cervical biopsies, respectively. Three of the centers provided biopsies. Additionally, the presence of perivascular stromal inflammation was recorded. During discussions after the first round, further histological lesions (venous endothelial inflammation and apoptosis) were identified for closer evaluation and added to the panel of lesions to score in the second round. All participants completed a questionnaire to explore current practices in handling and reporting uterus transplant biopsies.
Results: Cervical biopsies were commonly performed in all centers to monitor rejection. Intraobserver reproducibility of rejection grading (performed by 1 rater) was excellent, whereas interobserver reproducibility was moderate and did not improve in the second round. Reproducibility of perivascular stromal inflammation was moderate but unsatisfactory for venous endothelial inflammation and apoptosis. All lesions were more frequent in, but not restricted to, biopsies with rejection patterns.
Conclusions: Grading of rejection in cervical biopsies is reproducible and applicable to biopsies from different centers. Diagnosis of rejection may be improved by adding further histological lesions to the grading system; however, lesions require rigorous consensus definition.
Competing Interests: The authors declare no conflicts of interest.
(Copyright © 2023 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)
Methods: We present a multicenter study in which 5 pathologists from 4 uterus transplantation centers performed 2 rounds of grading on 145 and 48 cervical biopsies, respectively. Three of the centers provided biopsies. Additionally, the presence of perivascular stromal inflammation was recorded. During discussions after the first round, further histological lesions (venous endothelial inflammation and apoptosis) were identified for closer evaluation and added to the panel of lesions to score in the second round. All participants completed a questionnaire to explore current practices in handling and reporting uterus transplant biopsies.
Results: Cervical biopsies were commonly performed in all centers to monitor rejection. Intraobserver reproducibility of rejection grading (performed by 1 rater) was excellent, whereas interobserver reproducibility was moderate and did not improve in the second round. Reproducibility of perivascular stromal inflammation was moderate but unsatisfactory for venous endothelial inflammation and apoptosis. All lesions were more frequent in, but not restricted to, biopsies with rejection patterns.
Conclusions: Grading of rejection in cervical biopsies is reproducible and applicable to biopsies from different centers. Diagnosis of rejection may be improved by adding further histological lesions to the grading system; however, lesions require rigorous consensus definition.
Competing Interests: The authors declare no conflicts of interest.
(Copyright © 2023 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)