Faculty Collaboration Database

Liver biopsy findings in patients with hematopoietic cell transplantation. Hum Pathol 2017 Aug;66:136-143

Date

07/10/2017

Pubmed ID

28688898

DOI

10.1016/j.humpath.2017.06.011

Scopus ID

2-s2.0-85026914113 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

Liver dysfunction is a frequent complication after hematopoietic cell transplantation. Liver biopsy has an important role for confirming the diagnosis of graft-versus-host disease (GVHD) or other liver diseases. The histological features of GVHD are not specific, and GVHD and other coexisting diseases may be present in the same biopsy, which makes the histologic interpretation of the liver biopsy more complex and challenging. The aim of the study is to improve the present diagnostic criteria. Fifty-two liver biopsies were studied. Most biopsies (47, 92%) showed some features of GVHD. Five (9.6%) had no GVHD, 20 (38.5%) had possible GVHD, and 27 (51.9%) had likely GVHD. Histologic features were analyzed semi-quantitatively and scored. Bile duct damage and intraepithelial lymphocytes were significantly more frequent in likely GVHD groups. Bile duct injury score calculated as the sum of bile duct damage and intraepithelial lymphocytes score was 2.3 in no GVHD and possible GVHD groups, and 4.2 in likely GVHD group (P<.001). A bile duct injury score ≥4 correlated well with a diagnosis of GVHD, with sensitivity 74% and specificity 88%. Many cases (36; 70.6%) had a concurrent disease process. Drug-induced liver injury (8, 16%) and sinusoidal obstruction syndrome (6, 12%) are particularly important causes of liver dysfunction. Moderate degree of bile duct injury and intraepithelial lymphocytes were the most helpful histologic findings to confirm the diagnosis of GVHD. In addition, it is important for the pathologist to be aware of the etiologies of liver dysfunction other than GVHD.

Author List

Eskandari F, Rowan DJ, Hari P, Kapke J, Schneidewend R, E Hagen C, Oshima K

Author

Parameswaran Hari MD Adjunct Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Area Under Curve
Bile Ducts
Biopsy
Diagnosis, Differential
Female
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Liver
Lymphocytes
Male
Middle Aged
Predictive Value of Tests
ROC Curve
Reproducibility of Results
Severity of Illness Index
Treatment Outcome
Young Adult