Hepatitic graft-versus-host disease after hematopoietic stem cell transplantation: clinicopathologic features and prognostic implication.

Abstract

BACKGROUND:

Graft-versus-host disease (GVHD) of the liver after allogeneic hematopoietic stem cell transplantation classically presents with increased bilirubin and alkaline phosphatase (ALP) levels. A hepatitic variant was recently recognized, with more than a 10-fold increase in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. This study defines the clinicopathologic features and prognostic implications of hepatitic GVHD compared with classic liver GVHD.

METHOD:

A total of 38 cases of hepatitic GVHD, 68 cases of classic liver GVHD, and 13 cases of hepatitis B virus (HBV)-related hepatitis after hematopoietic stem cell transplantation were analyzed.

RESULTS:

Hepatitic GVHD cases showed significantly higher ALT, AST, and ALP levels compared with classic liver GVHD cases (at onset, mean ALT: 154 vs. 58 U/L, P <0.001; AST: 167 vs. 77 U/L, P <0.001; at peak, ALT: 435 vs. 112 U/L, P <0.001; AST: 587 vs. 150 U/L, P <0.001; ALP: 416 vs. 238 U/L, P =0.001), persisted longer (74 vs. 32 days, P =0.006), and showed more lobular pathologic changes in biopsy (lobular changes: 16/26 vs. 4/19, P =0.007; hepatocyte necrosis: 16/26 vs. 6/19, P =0.008; acidophil bodies: 15/26 vs. 4/19, P =0.014) but less cholestasis (4/26 vs. 8/19, P =0.045). However, cumulative doses of immunosuppressants prescribed, response, and outcome were similar. Compared with hepatitic GVHD, HBV-related hepatitis occurred later (95 vs. 184 days, P =0.049), but clinical and biochemical profiles were similar, requiring liver biopsies for their distinction.

CONCLUSIONS:

Hepatitic and classic liver GVHD differed biochemically and pathologically, but these differences showed no obvious impact on outcome. The distinction of hepatitic GVHD from other hepatitis is mandatory.

• Authors: Shing Y Ma, Wing Y Au, Irene O L Ng, Albert K W Lie, Anskar Y H Leung, Raymond Liang, George K K Lau, Yok L Kwong
• Journal: Transplantation (Transplantation) Vol. 77 Issue 8 Pg. 1252-9 (Apr 27 2004) ISSN: 0041-1337 [Print] United States
• PMID: 15114094 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Aspartate Aminotransferases
• Alanine Transaminase
• Alkaline Phosphatase
• Bilirubin

Topics

• Adolescent
• Adult
• Alanine Transaminase (blood)
• Alkaline Phosphatase (blood)
• Aspartate Aminotransferases (blood)
• Bilirubin (blood)
• Female
• Graft vs Host Disease (drug therapy, etiology, pathology)
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Hepatitis (drug therapy, etiology, pathology)
• Hepatitis B (drug therapy, etiology, pathology)
• Humans
• Liver Diseases (drug therapy, etiology, pathology)
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Transplantation, Homologous
• Treatment Outcome