Definition
Attack by engrafted hematopoietic cells and their progeny on the host liver
Diagnostic Criteria
Early phase
Lymphoplasmacytic infiltration of portal tracts Damage to bile duct epithelium
Cytoplasmic swelling and vacuolation
Enlarged and overlapping nuclei (reactive epithelial atypia)
Apoptosis
Late phase
Loss of bile ducts Increased fibrosis
Neeraja Kambham MD
Original posting : May 9, 2007
Supplemental studies
Immunohistology
Useful for detection of hepatitis B and other viral diseases
Differential Diagnosis
Chronic viral hepatitis C
Dense lymphoid aggregates
Interface hepatitis
Acidophil bodies
Drug induced damage
Chemoirradiation effects last 3-4 weeks
Other drugs can have hepatitis or cholestatic picture or granulomas
Primary biliary cirrhosis
Can be difficult to distinguish from GVHD
Features favoring PBC
Granulomas if present
Florid bile duct lesions
Venocclusive disease
Due to chemotherapy and radiation toxicity
Usually presents 3 weeks after therapy
Endothelial injury in sinusoids and venules
May have fibrin thrombi
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
Grading
Grade
Bile ducts showing epithelial damage
I
<25%
II
25-49%
III
50-74%
IV
75-100%
(Not widely performed)
Lists
Principal sites of graft versus host disease
Skin
Gastrointestinal tract
Liver
Bibliography
Shulman HM, Kleiner D, Lee SJ, Morton T, Pavletic SZ, Farmer E, Moresi JM, Greenson J, Janin A, Martin PJ, McDonald G, Flowers ME, Turner M, Atkinson J, Lefkowitch J, Washington MK, Prieto VG, Kim SK, Argenyi Z, Diwan AH, Rashid A, Hiatt K, Couriel D, Schultz K, Hymes S, Vogelsang GB. Histopathologic diagnosis of chronic graft-versus-host disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: II. Pathology Working Group Report. Biol Blood Marrow Transplant. 2006 Jan;12(1):31-47.
Heymer B. Clinical and diagnostic pathology of graft versus host disease. Springer Verlag, 2002.
