Pathology of Graft vs. Host Disease pp 169-183 | Cite as
The Pathological Spectrum of Hepatic GVHD
Abstract
Liver GVHD has declined in recent years but still remains a serious complication of HSCT. The characteristic features involve damaged small bile ducts and cholestasis. There are several different presentations of liver GVHD including those which present as acute GVHD with skin and especially gut involvement. Prolonged acute GVHD of the liver first targets and destroys bile ducts, leading to marked secondary changes of cholestasis. Another presentation of GVHD occurs later as a slowly progressing cholestatic injury without elevations of aminotransferases. Evaluation of liver GVHD involves cytokeratin immunostaining, which helps identify and quantify the bile ducts, and other stains including the periodic acid-Schiff (PAS) stain, which highlights the hepatic architecture and helps identify abnormal and damaged bile ducts. The interpretation of posttransplant liver biopsies must incorporate clinical factors including time posttransplant, exposure to immunosuppression, and other potential causes including drug-induced liver injury (DILI).
Keywords
Hepatic GVHD Bile duct injury Cholestatic liver disease Vanishing bile ducts Ductopenia Cholangitis lentaReferences
- 1.Lefkowitch JH, Lobritto SJ, Brown RS Jr, et al. Ground-glass, polyglucosan-like hepatocellular inclusions: a “new” diagnostic entity. Gastroenterology. 2006;131(3):713–8.CrossRefGoogle Scholar
- 2.Wisell J, Boitnott J, Haas M, et al. Glycogen pseudoground glass change in hepatocytes. Am J Surg Pathol. 2006;30(9):1085–90.CrossRefGoogle Scholar
- 3.Keel SB, Abkowitz JL. The microcytic red cell and the anemia of inflammation. N Engl J Med. 2009;361(19):1904–6.CrossRefGoogle Scholar
- 4.Kamble RT, Selby GB, Mims M, Kharfan-Dabaja MA, Ozer H, George JN. Iron overload manifesting as apparent exacerbation of hepatic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. BiolBlood Marrow Transplant. 2006;12(5):506–10.CrossRefGoogle Scholar
- 5.Kida A, McDonald GB. Gastrointestinal, hepatobiliary, pancreatic, and iron-related diseases in long-term survivors of allogeneic hematopoietic cell transplantation. Semin Hematol. 2012;49(1):43–58.CrossRefGoogle Scholar
- 6.McDonald GB, Frieze D. A problem-oriented approach to liver disease in oncology patients. Gut. 2008;57(7):987–1003.CrossRefGoogle Scholar
- 7.Matsukuma KE, Wei D, Sun K, Ramsamooj R, Chen M. Diagnosis and differential diagnosis of hepatic graft versus host disease (GVHD). J Gastrointest Oncol. 2016;7(Suppl 1):S21–31.PubMedPubMedCentralGoogle Scholar
- 8.Shulman HM, Cardona DM, Greenson JK, et al. NIH consensus development project on criteria for clinical trials in chronic graft-versus-host disease: II. The 2014 pathology working group report. Biol Blood Marrow Transplant. 2015;21(4):589–603.CrossRefGoogle Scholar
- 9.Stueck AE, Schiano TD, Fiel MI. Development of a novel histologic diagnostic algorithm for hepatic graft-versus-host disease. Mod Pathol. 2018;31(3):442–51.CrossRefGoogle Scholar
- 10.Strasser SI, Sullivan KM, Myerson D, et al. Cirrhosis of the liver in long-term marrow transplant survivors. Blood. 1999;93(10):3259–66.PubMedGoogle Scholar
- 11.O’Shea AM, Wilson GJ, Ling SC, Minassian BA, Turnbull J, Cutz E. Lafora-like ground-glass inclusions in hepatocytes of pediatric patients: a report of two cases. Pediatr Dev Pathol. 2007;10(5):351–7.CrossRefGoogle Scholar
- 12.Kleiner DE. Liver histology in the diagnosis and prognosis of drug-induced liver injury. Clinical Liver Disease. 2014;4(1):12–6.CrossRefGoogle Scholar
- 13.Shulman HM, Sharma P, Amos D, Fenster LF, McDonald GB. A coded histologic study of hepatic graft-versus-host disease after human bone marrow transplantation. Hepatology. 1988;8(3):463–70.CrossRefGoogle Scholar
- 14.Gooley TA, Rajvanshi P, Schoch HG, McDonald GB. Serum bilirubin levels and mortality after myeloablative allogeneic hematopoietic cell transplantation. Hepatology. 2005;41(2):345–52.CrossRefGoogle Scholar
- 15.Pidala J, Chai X, Kurland BF, et al. Analysis of gastrointestinal and hepatic chronic graft-versus-host [corrected] disease manifestations on major outcomes: a chronic graft-versus-host [corrected] disease consortium study. Biol Blood Marrow Transplant. 2013;19(5):784–91.CrossRefGoogle Scholar