Hepatic Graft Versus Host Disease: A Study of the Predictive Value of Liver Biopsy in Diagnosis

Ninety‐six liver biopsies [32 bone marrow transplant (BMT), 7 pre‐BMT, and 57 non‐BMT] are reviewed for histological evidence of graft versus host disease (GVHD), based on bile duct atypia and related inflammatory changes. In addition, the presence of cholestasis, piecemeal necrosis, and attachment...

Full description

Saved in:
Bibliographic Details
Published in:Hepatology (Baltimore, Md.) Md.), 1984-01, Vol.4 (1), p.123-130
Main Authors: Snover, Dale C., Weisdorf, Sally A., Ramsay, Norma K., Mcglave, Philip, Kersey, John H.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Biopsy
Bone Marrow Transplantation
Bone marrow, stem cells transplantation. Graft versus host reaction
Child, Preschool
False Positive Reactions
Female
Graft vs Host Disease - diagnosis
Humans
Liver - pathology
Male
Medical sciences
Middle Aged
Necrosis
Retrospective Studies
Transfusions. Complications. Transfusion reactions. Cell and gene therapy
Transplantation, Homologous
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Ninety‐six liver biopsies [32 bone marrow transplant (BMT), 7 pre‐BMT, and 57 non‐BMT] are reviewed for histological evidence of graft versus host disease (GVHD), based on bile duct atypia and related inflammatory changes. In addition, the presence of cholestasis, piecemeal necrosis, and attachment of lymphocytes to vascular endothelium (endothelialitis) are evaluated. The 57 non‐BMT biopsies include examples of viral hepatitis (acute and chronic), nonviral chronic hepatitis, extrahepatic biliary obstruction, cytomegalovirus hepatitis, primary biliary cirrhosis, and orthotopic liver transplant rejection. Although the sensitivity of bile duct damage as an indicator of GVHD appears high (only one probable false negative was noted), there is considerable overlap between the changes of GVHD and occasional cases of acute and chronic hepatitis and extrahepatic biliary obstruction. Nine of the 57 non‐BMT biopsies (15%) were felt to be consistent with GVHD and represent “false positives”. Despite this relative lack of specificity, analysis of several features in combination provided clues to improve accuracy of diagnosis. The findings of extensive bile duct damage with minimal inflammatory changes is characteristic of GVHD. Possibly more predictive is the presence of endothelialitis of portal or central veins, which was seen in only three non‐BMT biopsies, being present in eight cases of GVHD.
ISSN:0270-9139
1527-3350
DOI:10.1002/hep.1840040122