Liver and intrahepatic bile ducts - nontumor
Acute graft versus host disease (GVHD)

Author: Komal Arora, M.D. (see Authors page)

Revised: 13 November 2017, last major update May 2012

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Acute graft versus host disease[TI] liver[TI]

Cite this page: Arora, K. Acute graft versus host disease (GVHD). website. Accessed July 23rd, 2018.
Definition / general
  • 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)
  • Elevated serum alkaline phosphatase > 2x normal, liver biopsy with typical features and no other cause for cholestatic liver disease after ultrasound, biopsy and followup
Microscopic (histologic) description
  • 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
Additional references