GVHD was classified as acute if less than 100 days from transplant and chronic if greater than 100 days.
Histologic findings seen in a liver biopsy from a patient with GVHD:
(1) extensive bile duct damage (ratio of damaged vs total number of ducts greater than 50%)
(2) relatively sparse inflammation in the portal tracts consisting primarily of lymphocytes
(3) lymphocytic endothelialitis (lymphocytes attached to luminal surface of the endothelium) of portal and/or central veins
Bile duct damage in GVHD may include:
(1) epithelial dropout or necrosis
(2) nuclear pleomorphism
(3) nuclear overlap
(4) epithelial cytoplasmic vacuolization
Parenchymal necrosis may or may not be present. If present the degree of inflammation may be relatively sparse.
When to be cautious in making the diagnosis of GVHD in a liver biopsy:
(1) polymorphonuclear white cells or marked inflammation in the portal tracts
(2) bile lakes or bile duct plugs (favor extrahepatic biliary obstruction)
(3) absence of endotheliatis
(4) presence of liver disease prior to transplant
(5) evidence of viral hepatitis
(6) extensive hepatocellular necrosis in chronic GVHD (> 100 days after transplant)
