Hepatitic graft-versus-host disease after hematopoietic stem cell transplantation: clinicopathologic features and prognostic implication.
ABSTRACT Graft-versus-host disease (GVHD) of the liver after allogeneic hematopoietic stem cell transplantation classically presents with increased bilirubin and alkaline phosphatase (ALP) levels. A hepatitic variant was recently recognized, with more than a 10-fold increase in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. This study defines the clinicopathologic features and prognostic implications of hepatitic GVHD compared with classic liver GVHD.
A total of 38 cases of hepatitic GVHD, 68 cases of classic liver GVHD, and 13 cases of hepatitis B virus (HBV)-related hepatitis after hematopoietic stem cell transplantation were analyzed.
Hepatitic GVHD cases showed significantly higher ALT, AST, and ALP levels compared with classic liver GVHD cases (at onset, mean ALT: 154 vs. 58 U/L, P <0.001; AST: 167 vs. 77 U/L, P <0.001; at peak, ALT: 435 vs. 112 U/L, P <0.001; AST: 587 vs. 150 U/L, P <0.001; ALP: 416 vs. 238 U/L, P =0.001), persisted longer (74 vs. 32 days, P =0.006), and showed more lobular pathologic changes in biopsy (lobular changes: 16/26 vs. 4/19, P =0.007; hepatocyte necrosis: 16/26 vs. 6/19, P =0.008; acidophil bodies: 15/26 vs. 4/19, P =0.014) but less cholestasis (4/26 vs. 8/19, P =0.045). However, cumulative doses of immunosuppressants prescribed, response, and outcome were similar. Compared with hepatitic GVHD, HBV-related hepatitis occurred later (95 vs. 184 days, P =0.049), but clinical and biochemical profiles were similar, requiring liver biopsies for their distinction.
Hepatitic and classic liver GVHD differed biochemically and pathologically, but these differences showed no obvious impact on outcome. The distinction of hepatitic GVHD from other hepatitis is mandatory.
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ABSTRACT: Human herpesvirus 6B (HHV-6B) is an opportunistic pathogen associated with a growing number of complications in immunocompromised patients. Multiple reports of HHV-6B-associated hepatitis following primary HHV-6 infection and liver transplantation have appeared, but this has only been well documented in 1 patient after hematopoietic cell transplantation (HCT). This report describes a case of acute hepatitis likely caused by HHV-6B in an HCT recipient who was successfully treated with ganciclovir. HHV-6B DNA was demonstrated in plasma and hepatic tissue using quantitative polymerase chain reaction and immunohistochemical stains. Chromosomal integration was ruled out. We review the literature reporting HHV-6B-associated hepatitis, which may be an underappreciated cause of liver disease after HCT.Transplant Infectious Disease 04/2014; · 1.98 Impact Factor
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ABSTRACT: Science and technology of Republican China (1912-1949) often replicated the West in all hierar- chies. However, in 1949 when the Chinese Communist Party (CCP) declared the nation the Peo- ple's Republic of China, it had assumed Soviet pseudo-science, namely neo-Lamarckian and anti- Mendelian Lysenkoism, which led to intense propaganda campaigns that victimized intellectuals and natural scientists. Not until the 1956 Double Hundred Campaign had China engaging in meaningful exploration into modern genetics with advancements of Morgan. The CCP encour- aged discussions on the impact of Lysenkoism which cultivated guidelines to move science for- ward. However, Mao ended the campaign by asserting the Anti-Rightist Movement (1957) that reinstated the persecution of intellectuals, for he believed they did not contribute to his socialist ethos of the working people. The Great Leap Forward (1958-1959), an idealist and unrealistic attempt to rapidly industrialize the nation, and the Cultural Revolution (1966-1976), a grand at- tempt to rid China of the "technological elite," extended China's lost years to a staggering two decades. Post-Mao China rapidly revived its science and technology frontier with specialized sci- ences: agricultural biotechnology, major genomic ventures, modernizing Traditional Chinese Medicine, and stem-cell research. Major revisions to the country's patent laws increased interna- tional interest in China's resources. However, bioethical and technical standards still need to be implemented and locally and nationally monitored if China's scientific advances are to be glob- ally accepted and commercialized.