CYTOMEGALOVIRUS IN LIVER BIOPSIES OF MARROW TRANSPLANT RECIPIENTS - DETECTION METHODS, CLINICAL, HISTOLOGICAL AND IMMUNOHISTOLOGICAL FEATURES

In a retrospective analysis liver biopsy specimens obtained from 44 ma rrow transplant recipients were studied to evaluate the frequency of l ocal presence of human cytomegalovirus (CMV) and graft-versus-host dis ease (GVHD)-like histological and immunohistological alterations in pa tients with and without liver dysfunction following bone marrow transp lantation (BMT). In 22 of 28 patients with marked liver dysfunction af ter BMT and histopathological alterations described as typical for acu te GvHD CMV could be detected in the liver biopsy specimen. The polyme rase chain reaction (PCR) technique revealed the highest sensitivity f or CMV detection in liver biopsy samples, but in 20 of 22 PCR-positive specimens CMV infection could be confirmed by at least one additional technique. All the liver biopsies obtained from 16 patients with norm al liver function lacking histopathological signs of GvHD were CMV neg ative. In all 3 patients with CMV-positive liver biopsy started on ant iviral therapy liver function improved and no generalized CMV disease occurred. All the 4 patients without local presence of CMV started on severe immunosuppressive therapy showed an improvement of liver dysfun ction without occurrence of CMV infection. Local CMV infection of the liver could not be differentiated from hepatic GVHD by clinical and hi stopathological features, nor by immunohistological analysis of the bi le duct epithelium. In contrast, only in liver biopsy with local viral presence could an increase in HLA class II- and ICAM-1 expression be demonstrated on hepatocytes. Thus, especially the high negative predic tive value of the PCR technique helps to manage the patient with liver dysfunction after BMT.