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Hepatitic pattern of graft versus host disease in children
Author(s) -
MelínAldana Héctor,
Thormann Kimberly,
Duerst Reggie,
Kletzel Morris,
Jacobsohn David A.
Publication year - 2006
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.21069
Subject(s) - medicine , immunosuppression , bile duct , etiology , graft versus host disease , pathology , pathogenesis , biopsy , disease , hepatocellular carcinoma , gastroenterology
Background Liver involvement by graft‐versus‐host disease (GVHD) is characterized histologically by bile duct damage, which may be severe. A different pattern, “hepatitic GVHD,” has been described in adult patients. This pattern also shows marked lobular hepatitis and hepatocellular damage. We report the development of hepatitic GVHD in six pediatric patients. Procedure Clinical information and histologic features of liver biopsy samples were retrospectively reviewed. Results Patients' ages ranged from 3 to 11 years. Underlying diagnosis, pre‐transplant conditioning and GVHD prophylaxis varied. Peripheral blood stem cells were the source of the allograft in four patients, matched sibling in one, and matched‐unrelated donor in one. Hepatic GVHD was detected between 149 and 310 days post‐transplant. Prior acute GVHD had developed in two patients, and involved the skin and/or gastrointestinal tract. No patients had significant ductopenia. Only one patient had significant lymphocytic infiltration of bile ducts (ductitis). Bile duct epithelial damage and significant portal/periportal inflammation were present in all patients. Lobular necro‐inflammation was present in five patients. Five patients improved with immunosuppression and one died with progressive GVHD. Conclusions This series focuses on hepatitic GVHD in pediatric patients. Clinical and histologic patterns are similar to what has been described in adults. Specific etiology and pathogenesis of this entity remain unclear. Pediatr Blood Cancer 2007;49:727–730. © 2006 Wiley‐Liss, Inc.