Histopathology of graft versus host disease of the liver

Abstract

BDD is the predominant change in L-GVHD. In about a quarter of biopsies the appearance may be of a lobular hepatitis. L-GVHD is not a fibrogenic process. The significance of separating acute versus chronic L-GVHD based on a cut-off of 100 days post-HSCT is questionable. Further studies are needed to understand the relationships between the mechanisms of BDD, bile duct loss and regeneration.

NIH Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: II. The 2014 Pathology Working Group Report

“…Therefore, it seems likely that individual histological features should be associated with the outcome of HCT patients or predict response to therapy. Yet, because of small sample sizes, case accrual over long times periods and changes in conditioning and treatment modalities, comparisons between these histological studies are difficult [52]. For example, in one study, the extent of bile duct damage, lymphocytic infiltration of biliary epithelium, portal inflammation, and ductopenia showed no association with survival, while severe acinar inflammation and low level of hepatocellular ballooning were associated with a better outcome [53].…”

Pathology of Pediatric Gastrointestinal and Liver Disease

“…A liver biopsy is considered safe for diagnostic purpose to guide the clinical management of the child in this situation Beschorner et al 1980 ;Duarte et al 2005 ;Subbarao et al 2006 ;Oshrine et al 2011 ). Early recognition of acute liver GVHD warrants aggressive treatment in order to reverse the course and prevent development of chronic GVHD Arai et al 2002 ;Duarte et al 2005 ;Melin-Aldana et al 2007 ;Quaglia et al 2007 ). 15.22 ) Liver involvement usually manifests itself 2-3 weeks posttransplant with jaundice, nausea and vomiting, and increased liver enzymes and bilirubin in severe cases.…”

Efficacy of bezafibrate for chronic GVHD of the liver after allogeneic hematopoietic stem cell transplantation

“…Chronic liver GVHD is one of the most serious problems related to long-term survival. It is characterized by the destruction of bile duct epithelium followed by progressive cholestasis, with elevations in serum alkaline phosphatase (ALP), g-glutamyl transpeptidase (g-GTP) and serum bilirubin levels; 5,6 it resembles primary biliary cirrhosis (PBC) clinically and histologically. [7][8][9] Ursodeoxycholic acid (UDCA), which is widely accepted as the standard medical treatment with documented efficacy, 10 is also used for the treatment of cGVHD of the liver, along with corticosteroids and calcineurin inhibitors.…”