Hepatic graft-versus-host disease presenting as an acute hepatitis after allogeneic peripheral blood stem cell transplantation

Abstract

Summary:Hepatic graft-versus-host disease (GVHD) generally presents as cholestatic jaundice, and increased serum alkaline phosphatase (ALP) is followed by hyperbilirubinemia and clinical jaundice. Currently accepted standards for evaluating the clinical severity of GVHD are based not on serum aminotransferase levels but on the serum bilirubin level. We describe a 17-year-old Japanese female who had increased aminotransferases without cholestasis on day 23 after allogeneic peripheral blood stem cell transplantation (allo-PBSCT). Liver biopsy revealed lymphocytic infiltration of the portal tracts and pericentral necrosis of the lobuli. The limiting plates were not clearly defined due to cellular infiltrates. There was periductal lymphocytic infiltration and vacuolization of the biliary epithelial cells with exocytosis, compatible with GVHD of cholangiohepatitic type. These findings indicate that acute hepatic GVHD may present as acute hepatitis and this should be included in the differential diagnosis for patients with increased aminotransferases after allogeneic stem cell transplantation. Bone Marrow Transplantation (2001) 27, 1007-1010.

Clinical differentiation of acute cutaneous graft-versus-host disease from drug hypersensitivity reactions

“…Hyperbilirubinemia is the most frequent sign of liver GVHD. 12 However, the presence of hyperbilirubinemia was not different between the GVHD and DHR groups. This was largely a result of the presence of veno-occlusive disease in the patients with DHR.…”

Stem cells in clinical practice: applications and warnings

“…diarrhea, emesis, anorexia, abdominal pain, mucosal ulceration with bleeding, luminal dilatation [95], and in the liver, i.e. same liver dysfunction of veno-occlusive disease, drug toxicity, viral infection, sepsis, or iron overload [96]. Chronic GVHD is the major cause of late non-relapse death following HCT [97].…”

Hepatitic variant of graft-versus-host disease after donor lymphocyte infusion

“…Strasser et al 6 report their observations in 14 patients in whom chronic GVHD of the liver was accompanied by marked elevations of serum aminotransferase levels, clinically resembling acute viral hepatitis. 6 Similarly, Fujii et al 7 report a patient with liver GVHD, thought to be acute hepatitis, 23 days after allogeneic peripheral blood stem cell transplantation (SCT). 7 In another case report, chronic GVHD, also thought to be acute hepatitis, 36 weeks after matched-unrelated allogeneic SCT for chronic myelogenous leukemia was described.…”

“…6 Similarly, Fujii et al 7 report a patient with liver GVHD, thought to be acute hepatitis, 23 days after allogeneic peripheral blood stem cell transplantation (SCT). 7 In another case report, chronic GVHD, also thought to be acute hepatitis, 36 weeks after matched-unrelated allogeneic SCT for chronic myelogenous leukemia was described. 8 In the present case series of 22 patients, we report our clinical observations of this hepatitic variant of liver GVHD that occurred after donor lymphocyte infusion (DLI).…”