Clinicopathological features in patients with hepatic graft-versus-host disease.
OBJECTIVE
Hepatic graft-versus-host disease (GVHD) is a frequent complication after bone marrow transplantation and often results in a fatal outcome. However, hepatic manifestation of chronic GVHD accompanied by unresolved acute GVHD has not been clarified so far. The present study was intended to examine clinicopathological features in patients in which acute GVHD appeared to progress gradually into chronic GVHD.


METHODS
We evaluated laboratory data, pathological features and response to immunosuppression in 11 patients whose diseases were diagnosed as hepatic GVHD, retrospectively. The patients were classified into 3 groups: acute GVHD group (n=3), non-progressive chronic GVHD group (n=5) and progressive chronic GVHD group (n=3), which means continuous liver dysfunction beyond day 100 post-transplant.


RESULTS
Patients with progressive chronic GVHD showed higher peaks of aminotransferase and biliary tract enzyme levels than patients with acute GVHD and non-progressive chronic GVHD. Their biopsy specimens demonstrated severer changes in lobular parenchyma, portal area and small interlobular bile ducts. They also showed marked loss of bile ducts. Despite administration of prednisolone or dose escalation of cyclosporin A, their liver function tests did not return to normal within one year.


CONCLUSIONS
In cases of liver dysfunction that emerges within 100 days after transplantation, liver biopsy appears to be important to confirm diagnosis. Patients with acute hepatic GVHD need strong immunosuppression to prevent progression to chronic GVHD.
Chiba
Tetsuhiro
T
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Japan.
Yokosuka
Osamu
O
Goto
Shigemasa
S
Fukai
Kenichi
K
Imazeki
Fumio
F
Kohno
Yoichi
Y
Nishimura
Miki
M
Saito
Yasushi
Y
Saisho
Hiromitsu
H
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001707:Biopsy, Needle; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000473:pathology* / Q000503:physiopathology; D019337:Hematologic Neoplasms / Q000473:pathology / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008107:Liver Diseases / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents