title: Hepatitic variant of graft-versus-host disease after donor lymphocyte infusion.
abstract: Graft-versus-host disease (GVHD) of the liver is characterized by bile duct damage and portal lymphocytic infiltrate. We report acute hepatitislike presentation of GVHD after donor lymphocyte infusion (DLI). Between April 1998 and September 2001, 73 patients received 94 DLI treatments. Liver GVHD developed after DLI in 22 (30%) patients whose median age was 43 years (range, 21 to 61 years). Onset of liver dysfunction was at 35 days (range, 11 to 406 days) after DLI. Fifteen patients underwent liver biopsy, and the diagnosis of liver GVHD was confirmed in 13 (87%) patients. After viral hepatitis and recent drug exposure were excluded, 11 (50%) patients were given a diagnosis of a hepatitic variant of GVHD based on histologic evidence of lobular hepatitis (n = 5), elevation of maximum serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level more than 10 times the upper normal limit (n = 9), or both. There was a significant difference in maximum ALT (P =.002) and AST (P =.01) level between the hepatitic-variant and classical GVHD groups. GVHD progressed in 14 (64%) patients, and 10 patients died after a median follow-up of 221 days (range, 31-1284 days). These observations suggest that GVHD that occurs after DLI may have distinct clinical features. Hepatitic-variant GVHD should be considered in the differential diagnosis in DLI recipients with unexplained hepatitis.
authors.affiliation: Department of Oncology, Pathology, and Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
authors.forename: Görgün
authors.initials: G
authors.lastname: Akpek
authors.forename: John K
authors.initials: JK
authors.lastname: Boitnott
authors.forename: Linda A
authors.initials: LA
authors.lastname: Lee
authors.forename: Jason P
authors.initials: JP
authors.lastname: Hallick
authors.forename: Michael
authors.initials: M
authors.lastname: Torbenson
authors.forename: David A
authors.initials: DA
authors.lastname: Jacobsohn
authors.forename: Sally
authors.initials: S
authors.lastname: Arai
authors.forename: Viki
authors.initials: V
authors.lastname: Anders
authors.forename: Georgia B
authors.initials: GB
authors.lastname: Vogelsang
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D016026:Bone Marrow Transplantation; D003937:Diagnosis, Differential; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D006505:Hepatitis / Q000473:pathology; D006801:Humans; D008107:Liver Diseases / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D017710:Lymphocyte Transfusion / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000410:Alanine Transaminase