Abstract
Typical liver Graft-versus-Host disease (GVHD) is characterized by cholestasis causing bile duct damage. The hepatitic variant of liver GVHD shows marked elevations of blood aminotransferases without significant elevation of biliary tract enzymes. Hepatitic GVHD may account for as many as 36% to 50% of cases of liver GVHD in adults but is rare in children. We describe a 4-year-old girl in whom hepatitic GVHD developed after allogenic hematopoietic stem cell transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia. The pathologic features of liver biopsy specimens were consistent with lobular hepatitis, with marked infiltration of CD8-positive T-cell predominating in portal areas. There was no cholangiolitis or B-cell or plasma cell infiltration, both of which play important roles in autoimmune hepatitis like liver GVHD. The cytokine/chemokine profile showed high expression of monocyte chemotactic protein-1, and macrophage inflammatory protein-1β in liver sample, suggesting that activation of monocytes/macrophages may be related with pathophysiology of hepatitic GVHD.
