Bile duct apoptosis and cholestasis resembling acute graft-versus-host disease after autologous hematopoietic cell transplantation

Michael D. Saunders, Howard M. Shulman, Carol S. Murakami, Thomas R. Chauncey, William I. Bensinger, George B. McDonald

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

BACKGROUND: Acute graft-versus-host disease (GVHD) of the liver is a frequent complication of allogeneic hematopoietic cell transplantation. This report describes hepatic GVHD following autologous transplantation. METHODS: We reviewed 116 consecutive autologous transplant recipients. A diagnosis of GVHD was based on histology (segmental to subtotal destruction of bile ductal epithelial cells with apoptosis and lymphocytic infiltrates), clinical criteria (elevated serum alkaline phosphatase), a response to immunosuppressive therapy, and finding no other cause for cholestatic liver disease. RESULTS: Two patients developed cholestatic liver disease (alkaline phosphatase levels over five times the normal upper limit) and had liver biopsies showing apoptotic and dysmorphic ductular epithelial cells typical of GVHD. Three additional patients developed cholestasis and intestinal symptoms but had gastric biopsies only, showing apoptotic crypt epithelial cells and crypt cell drop-out typical of GVHD. CONCLUSION: Two recipients of autologous hematopoietic cells developed histologic abnormalities of small bile ducts and cholestatic liver disease resembling GVHD of the liver after allogeneic transplant. The mechanisms of bile duct damage in this setting may involve immune dysregulation related to reconstitution of immunity with peripheral blood stem cells.

Original languageEnglish (US)
Pages (from-to)1004-1008
Number of pages5
JournalAmerican Journal of Surgical Pathology
Volume24
Issue number7
DOIs
StatePublished - Jul 1 2000

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Cholestasis
Cell Transplantation
Graft vs Host Disease
Bile Ducts
Apoptosis
Liver Diseases
Liver
Epithelial Cells
Alkaline Phosphatase
Biopsy
Autologous Transplantation
Autografts
Immunosuppressive Agents
Bile
Immunity
Stomach
Histology
Transplants
Serum

Keywords

  • Autologous transplantation
  • Bile duct injury
  • Cholestasis
  • Graft- versus-host disease
  • Hematopoietic cell transplantation

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

Cite this

Bile duct apoptosis and cholestasis resembling acute graft-versus-host disease after autologous hematopoietic cell transplantation. / Saunders, Michael D.; Shulman, Howard M.; Murakami, Carol S.; Chauncey, Thomas R.; Bensinger, William I.; McDonald, George B.

In: American Journal of Surgical Pathology, Vol. 24, No. 7, 01.07.2000, p. 1004-1008.

Research output: Contribution to journalArticle

Saunders, Michael D. ; Shulman, Howard M. ; Murakami, Carol S. ; Chauncey, Thomas R. ; Bensinger, William I. ; McDonald, George B. / Bile duct apoptosis and cholestasis resembling acute graft-versus-host disease after autologous hematopoietic cell transplantation. In: American Journal of Surgical Pathology. 2000 ; Vol. 24, No. 7. pp. 1004-1008.
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