Graft versus Host Disease (GVHD) of the Liver

Clinical

Acute vs. chronic GVHD: clinically 100 day cutoff
- Poor correlation between pathologic features and clinical definition of acute vs. chronic
Acute GVHD
- Develops 2-6 weeks after allogeneic transplant
- Primary targets
  - Skin 90%
  - Liver 40-60%
  - GI tract 30-50%
- Early recognition of GVHD and prompt intervention improves outcome
- Advanced GVHD easy to diagnose but mortality can be 50%
Chronic GVHD
- Resembles autoimmune connective tissue disorders
- Mortality is high due to infections promoted by GVHD associated immunodeficiency
- Target organs more widespread but skin, liver and GI tract play a major role
In liver typically presents as obstructive jaundice due to destruction of small intrahepatic bile ducts, similar to primary biliary cirrhosis