Histopathologic Study of the Liver after Allogeneic Bone Marrow Transplantation: Significance of Hepatic Graft-Versus-Host Disease

Postmortem livers from 38 cases were histologically examined to assess relative importance of hepatic graft-versus-host disease (GVHD) for liver dysfunction after allogeneic bone marrow transplantation. Hepatic GVHD, based on the finding of bile duct atypia, was present in 24 of 25 cases with clinical signs of GVHD (acute 14, chronic 11), and in none of 13 cases without clinical GVHD. Of the 25 cases with clinical GVHD17 (68%) had veno-occlusive disease (VOD), and 12 (48%) had opportunistic viral infections (cytomegalovirus 7, varicella-zoster virus 3, adenovirus 1, herpes simplex virus 1). Hepatic peliosis was present in two cases given azathioprine to suppress chronic GVHD. Azathioprine was also causal factor for the late occurrence of VOD in three cases. Extensive hepatocellular necrosis in the centrilobular region was found in a case treated with cyclosporin-A (CsA). All of the seven cases with hepatic failure had serious complications including VOD, peliosis, CsA hepatotoxicity and viral hepatitis either alone or in combination. In contrast, these hepatic comlications could not be found in five cases whithout cholestasis in the liver. Our results suggest that factors other than GVHD are responsible for severe cholestatic dysfunction of the liver.