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Hematopoietic Stem Cell Transplantation: Graft Versus Host Disease and Pathology of Gastrointestinal Tract, Liver, and Lung

Kambham, Neeraja MD*; Higgins, John P. MD*; Sundram, Uma MD, PhD*; Troxell, Megan L. MD, PhD

doi: 10.1097/PAP.0000000000000032
Review Articles

Hematopoietic stem cell transplantation (HCT), formerly known as bone marrow transplantation, is an integral part of treatment for many hematological malignancies. HCT is associated with several complications and comorbidities with differential effects on a wide spectrum of organs and tissues. We present an update on HCT-associated complications such as graft versus host disease (GVHD) and infection, with focus on the surgical pathology of the gastrointestinal (GI) tract, liver, and lung. Although the grading system for GI tract acute GVHD was proposed 40 years ago, recent studies have shed light on minimal histologic criteria for diagnosis of GVHD, as well as its differential diagnosis, including histologic effects of various medications. GI dysfunction in autologous transplant recipients is increasingly appreciated and patients are often biopsied. Acute liver injury in HCT is often due to sinusoidal obstruction syndrome (previously known as venoocclusive disease), or acute GVHD. Liver dysfunction at later time posttransplantation may be associated with acute or chronic GVHD, iron overload, or other causes of hepatitis. Lung injury in HCT is multifactorial, and it remains crucially important to diagnose and treat pulmonary infections. The pulmonary biopsy yields clinically unsuspected diagnoses in the majority of cases and its utilization is likely to increase. The pathology of the skin and kidney in HCT patients are detailed in accompanying articles.

*Department of Pathology, Stanford University School of Medicine, Stanford, CA

Department of Pathology, Oregon Health and Science University, Portland, OR

A portion of this material was presented at the USCAP annual meeting, March 2, 2014.

The authors have no funding or conflicts of interest to disclose.

Reprints: Neeraja Kambham, MD, Department of Pathology, Stanford University School of Medicine, L235 300 Pasteur Drive, Stanford, CA 94305 (e-mail: All figures can be viewed online in color at http://

© 2014 by Lippincott Williams & Wilkins.