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Liver and intrahepatic bile ducts-nontumor

Transplantation

Acute graft versus host disease (GVHD)


Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 27 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.

General
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● Frequent complication of allogeneic hematopoietic cell transplantation
● Usually affects skin, GI tract, liver
● Liver damage due to donor lymphocytes attacking liver epithelial cells, appears 10-50 days after bone marrow transplant
● Responds to immunosuppressive therapy (Blood 2002;100:3903, Transplantation 2004;77:1252)
Diagnosis: elevated serum alkaline phosphatase > 2x normal, liver biopsy with typical features and no other cause for cholestatic liver disease after ultrasound, biopsy and follow-up

Micro description
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● Damage to > 50% of bile ducts with vacuolated cytoplasm, nuclear pleomorphism and necrosis of individual cells (apoptosis)
● Lymphocytic infiltrate of portal tracts and veins (endothelialitis) with lifting of endothelium from its basement membrane
● May also have ballooning degeneration or acidophil bodies
Note: inflammatory infiltrate is limited because of bone marrow suppression early after transplant

Differential diagnosis
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● Viral hepatitis and drug related hepatitis (little bile duct damage)

Additional references
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Am J Surg Pathol 2000;24:1004

End of Liver and intrahepatic bile ducts-nontumor > Transplantation > Acute graft versus host disease (GVHD)


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