Sinusoidal Obstruction Syndrome Injury in Liver Biopsies after Hematopoietic Cell Transplantation
Changqing Ma, Elizabeth M Brunt. Washington University in St Louis, Saint Louis, MO
Background: The differential diagnosis of liver dysfunction after hematopoietic cell transplantation (HCT) is broad; early and severe findings favor sinusoidal obstruction syndrome (SOS) while later, graft-versus-host disease (GVHD), infection, drug toxicity, recrudescent or new viral hepatitis are likely. Although rarely discussed, post-HCT liver biopsies (Bxs) may show features of SOS injury. In this study we evaluated SOS injury in liver Bxs taken over a broad range of post-HCT period.
Design: Sixty-three consecutive liver Bxs for elevated liver tests (LT) with sufficient material were collected from 58 HCT patients. None had clinical parameters of SOS or hepatic/portal thrombosis on imaging. Hematoxylin & eosin, trichrome, reticulin, and Verhoeff-Van Gieson stained sections were scored for histologic lesions of SOS: occlusion, eccentric luminal narrowing, and/or phlebosclerosis of the terminal hepatic vein (THV), sinusoidal fibrosis, and centrilobular necrosis.
Results: The median number of days post-HCT for Bxs was 169 (range: 12 - 3304). Reported pathologic diagnoses were GVHD (75%), SOS without GVHD (5%), and "other" without GVHD or SOS (20%). Fifty-two (83%) Bxs had THV injuries. The median number of occluded THVs per Bx was 3 (range: 1-12); the average percentage of occlusion per Bx was 66%. Sinusoidal fibrosis and centrilobular necrosis were seen in 21 (33%) and 12 (19%), respectively. Stratified by time, 3 of 3 Bxs within 28 d of HCT, 20/22 (91%) between 28 - 100 d after HCT, 16/20 (80%) 100 d - 1 y, 9/13 (69%) 1 - 3 y, and 4/5 (80%) > 3 y after transplant had THV injuries. The frequencies of Bxs with occluded THV decreased from 100% within 28 d of HCT to 20% > 3 y after HCT. The frequencies of Bxs with THV narrowing and/or phlebosclerosis ranged from 100% to 80% (Figure 1). SOS injury ranged from 75% to 100% regardless of final diagnoses.
Conclusions: Our results demonstrate a high incidence and degree of SOS injury in Bxs of post-HCT patients with elevated LT regardless of time post-HCT, concurrent with other diagnoses. This high incidence likely reflects an aggregate of injuries pre- and post-HCT and the degree of injuries may adversely affect recovery. The presence and degree of injury to THV should be indicated when evaluating post-HCT Bxs for elevated LT.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 261, Monday Morning