Role of Skin Biopsy to Confirm Suspected Acute Graft-vs-Host Disease

Graft-Versus-Host Disease After Simultaneous Pancreas–Kidney Transplantation: A Case Report and Review of the Literature

“…The diagnosis of GVHD can be made on clinical indications and biopsy (17) but is facilitated by demonstrating donor lymphoid chimerism. A value greater than 20% more than 1-week posttransplant is highly specific (2).…”

The impact of histopathologic examination of graft-versus-host disease in the era of reduced-intensity conditioning regimen: a study from the Gruppo Italiano Trapianto di Midollo Osseo

“…Firoz et al [13] weighted the benefitrisk ratio of appropriate vs inappropriate treatment of GVHD, demonstrating in a hypothetical cohort of patients with suspected acute cutaneous GVHD after HSCT, that if the prevalence of GVHD is 30% or greater, the best outcome is obtained when patients are treated immediately without performing a skin biopsy. Otherwise, if prevalence is less than 30%, the best outcome is provided by a skin biopsy analysis before treatment [13]. In addition, failure to obtain prior histologic confirmation of cGvHD resulted in 7% of the referral patients being incorrectly diagnosed and treated for GvHD before their arrival [28].…”

“…The cutaneous manifestations of cGvHD are protean and have been recently revised by an expert panel at the NIH Consensus Conference in 2005 [6]. Criteria for the histopathologic diagnosis of GvHD have been modified over time [7][8][9][10][11], and the clinical value of biopsies for GvHD management is controversial [7,[12][13][14], especially within the first 3 weeks following bone marrow transplantation [15], a time during which histopathologic features are virtually indistinguishable from those due to non-GvHD-related conditions, like viral infections, drug reactions, engraftment syndrome associated with lymphocyte recovery, and toxicity from the pretransplant cytoreductive conditioning.…”

Graft-versus-Host-Disease (GvHD) – ein Update

“…Aufgrund der Variabilität des histopathologischen Bildes ist weniger die Spezifität dieser Untersuchung als vielmehr die Sensitivität in Zusammenschau aller Befunde für eine Diagnosefindung von entscheidender Bedeutung [14].…”