PATHOLOGY OF THE LIVER WITH BONE-MARROW TRANSPLANTATION - EFFECTS OF BUSULFAN, CARMUSTINE, ACUTE GRAFT VERSUS HOST-DISEASE, AND CYTOMEGALOVIRUS-INFECTION

  • 1 January 1980
    • journal article
    • research article
    • Vol. 99  (2) , 369-385
Abstract
The morphologic changes in the livers of autopsy specimens from [human] recipients of 62 allogeneic bone marrow transplants were reviewed and characterized in specimens from patients who had apparent drug toxicity, graft vs. host disease (GVHD) and disseminated cytomegalovirus (CMV) infection. Two conditioning protocols were associated with significant hepatic toxicity. Two of 3 recipients on whom autopsies were performed, who were prepared with high doses of carmustine, cyclophosphamide and total body irradiation, underwent acute hepatic failure and submassive necrosis with periportal sparing. Of 9 patients prepared with busulfan (16 or 20 mg/kg) and cyclophosphamide, 7 had moderate to marked centrilobular sinusoidal fibrosis and associated hepatocellular atrophy and necrosis. Twenty patients had acute cutaneous GVHD with associated hepatic dysfunction, including 8 with disseminated CMV infusion. Of the 12 patients without concomitant CMV infection, 5 had an early onset of GVHD and had predominantly periportal and focal midzonal hepatocellular necrosis and 7 had acute GVHD with later onset with predominantly bile duct injury. Fifteen patients had evidence of disseminated CMV infection. Whereas CMF infection alone was associated with both hepatocellular and bile duct injury, detectable virus infection was not a requirement for hepatocellular or bile duct injury associated with GVHD.