[1408] Clinicopathological Correlation and Grading of Graft Versus Host Disease of the Liver
S Hukku, G Bentley. Wayne State University/Detroit Medical Center, Detroit, MI
Background: Liver is the second most frequently involved target for graft versus host disease (GVHD), after skin, in patients with history of hematopoietic stem cell transplant. Prognosis is dependent on the overall grade of GVHD of which liver is an important parameter. There are no clear guidelines for grading GVHD of liver. The purpose of the study is to provide a clear, reproducible grading system for GVHD of the liver.
Design: Eighty-six liver biopsy specimens from hematopoietic stem cell transplant recipients obtained between 1999 to 2008, with a clinical suspicion of GVHD were reviewed to evaluate the histopathological changes of GVHD and iron deposition. Associations between these results and liver enzymes (AST, ALT, Alkaline phosphatase, total bilirubin) were sought. Cases with no morphological evidence of GVHD and hep B/C positivity were excluded. Seventy-three cases of GVHD were graded as mild, moderate and severe as follows: Mild: minimal lymphoplasmocytic infiltration of portal triads, nuclear anisocytosis and mild lymphocytic infiltration involving epithelium of some bile ducts. Moderate: moderate to severe portal inflammation and involvement of most bile ducts. Severe: moderate to severe portal inflammation and involvement of most bile ducts (moderate grade) plus lobular inflammation or bile duct loss or increased portal fibrosis. Iron (Prussian blue stain) deposition was scored minimal, mild, and moderate to severe: Minimal: scattered periportal hepatocytes with stainable iron. Mild: most periportal hepatocytes with stainable iron. Moderate/Severe: extension into lobules to virtually all hepatocytes with stainable iron.
Results: We found we could histologically divide GVHD into three categories: mild, moderate and severe, which have a statistically significant correlation with AST and Alkaline phosphatase levels. Severe Iron deposition may symptomatically mimic GVHD including elevations of transaminases. Our results show an inverse relationship of iron deposition with the severity of GVHD.
| GVHD | Mild (n=25) | Moderate(n=28) | Severe(n=20) | p value |
| AST | 187 175 | 374313 | 489336 | 0.002 |
| ALT | 397472 | 474363 | 544545 | 0.563 |
| Alk.Phos | 307286 | 500337 | 562434 | 0.040 |
| Total Bilirubin | 7.612 | 4.24.4 | 5.25.0 | 0.311 |
Conclusions: GVHD of the liver can be reliably graded as mild, moderate and severe. There is a stastically significant correlation between severity of GVHD and elevation of AST and Alkaline phosphatase. Also, severe iron deposition should be included in the differential for GVHD.
Category: Liver & Pancreas
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 206, Monday Morning