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Background  Skin biopsies are often used in daily practice for the diagnosis of acute (aGvHD) or chronic graft versus host disease (cGvHD). With the latest understanding in pathogenesis and new National Institute of Health (NIH) classifications for aGvHD and cGvHD, there is a need to evaluate the current prognostic value of histological grading cutaneous GvHD and its correlation to the clinical grade.    Methods  In a retrospective study with 120 skin biopsies (all taken for suspected GvHD) from 110 patients (all classified according to the NIH), biopsies were revised and graded, blinded for clinical information, for either acute of chronic features. Morphological grades were compared for concordance with the clinical grade and survival analyses were done for clinical and histological grading.    Results  Correlation for histologic vs. clinical grading was (very) poor for aGvHD and cGvHD (weighted  κ  − 0.038 and 0.0009, respectively). Patients with clinical aGvHD had worse prognosis compared to cGvHD. However, at time of biopsy neither clinical nor histological grading predicted the eventual survival for either aGvHD ( p  = 0.9739 and  p  = 0.0744, respectively) or cGvHD ( p  = 0.2149 and  p  = 0.4465, respectively).    Conclusions  Confirming the diagnosis of GvHD is still a valuable reason for taking a skin biopsy, but this study shows that histologic grading of GvHD in the skin biopsy has no additional value for clinicians in current practice.    Electronic supplementary material  The online version of this article (10.1186/s40001-019-0377-6) contains supplementary material, which is available to authorized users.

Clinical versus histological grading in the assessment of cutaneous graft versus host disease