Liver biopsy findings in patients with hematopoietic cell transplantation

Farzan Eskandari, Daniel J. Rowan, Parameswaran Hari, Jonathan Kapke, Robert Schneidewend, Catherine E. Hagen, Kiyoko Oshima

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)136-143
Number of pages8
JournalHuman Pathology
Volume66
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Fingerprint

Cell Transplantation
Graft vs Host Disease
Biopsy
Liver
Bile Ducts
Liver Diseases
Lymphocytes
Wounds and Injuries
Hepatic Veno-Occlusive Disease
Chemical and Drug Induced Liver Injury

Keywords

  • Diagnosis
  • Drug related liver injury
  • Graft-versus-host disease
  • Hematopoietic cell transplantation
  • Liver biopsy
  • Sinusoidal obstruction syndrome

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Eskandari, F., Rowan, D. J., Hari, P., Kapke, J., Schneidewend, R., E. Hagen, C., & Oshima, K. (2017). Liver biopsy findings in patients with hematopoietic cell transplantation. Human Pathology, 66, 136-143. https://doi.org/10.1016/j.humpath.2017.06.011

Liver biopsy findings in patients with hematopoietic cell transplantation. / Eskandari, Farzan; Rowan, Daniel J.; Hari, Parameswaran; Kapke, Jonathan; Schneidewend, Robert; E. Hagen, Catherine; Oshima, Kiyoko.

In: Human Pathology, Vol. 66, 01.08.2017, p. 136-143.

Research output: Contribution to journalArticle

Eskandari, F, Rowan, DJ, Hari, P, Kapke, J, Schneidewend, R, E. Hagen, C & Oshima, K 2017, 'Liver biopsy findings in patients with hematopoietic cell transplantation', Human Pathology, vol. 66, pp. 136-143. https://doi.org/10.1016/j.humpath.2017.06.011
Eskandari F, Rowan DJ, Hari P, Kapke J, Schneidewend R, E. Hagen C et al. Liver biopsy findings in patients with hematopoietic cell transplantation. Human Pathology. 2017 Aug 1;66:136-143. https://doi.org/10.1016/j.humpath.2017.06.011
Eskandari, Farzan ; Rowan, Daniel J. ; Hari, Parameswaran ; Kapke, Jonathan ; Schneidewend, Robert ; E. Hagen, Catherine ; Oshima, Kiyoko. / Liver biopsy findings in patients with hematopoietic cell transplantation. In: Human Pathology. 2017 ; Vol. 66. pp. 136-143.
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