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

BACKGROUND: Acute graft-versus-host disease (GVHD) of the liver is a freque nt complication of allogeneic hematopoietic cell transplantation. This repo rt describes hepatic GVHD following autologous transplantation. METHODS: We reviewed 116 consecutive autologous transplant recipients. A di agnosis of GVHD was based on histology (segmental to subtotal destruction o f bile ductal epithelial cells with apoptosis and lymphocytic infiltrates), clinical criteria (elevated serum alkaline phosphatase), a response to imm unosuppressive therapy, and finding no other cause for cholestatic liver di sease. RESULTS: Two patients developed cholestatic liver disease (alkaline phospha tase 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 bu t had gastric biopsies only, showing apoptotic crypt epithelial cells and c rypt cell drop-out typical of GVHD. CONCLUSION: Two recipients of autologous hematopoietic cells developed hist ologic abnormalities of small bile ducts and cholestatic liver disease rese mbling GVHD of the liver after allogeneic transplant. The mechanisms of bil e duct damage in this setting may involve immune dysregulation related to r econstitution of immunity with peripheral blood stem cells.