Differences in Liver Pathology and Clinical Outcome Between Two Patients with Hepatitis B Virus and Graft Versus Host Disease

Celalettin ÜSTÜN1, Muhit ÖZCAN1, Günhan GÜRMAN1, Mehtap ÇAKIR2, Selim EREKUL2, Gülen AKYOL4, Mutlu ARAT1, Harika ÇELEBI1, Ramazan IDLMAN3, Osman ILHAN1, Taner DEMIRER1, Meral BEKSAÇ1, Haluk KOÇ1

1Department of Hematology, Ankara University, School of Medicine, Ankara, Turkey
2Department of Pathology, Ankara University, School of Medicine, Ankara, Turkey
3Department of Gastroenterology, Ankara University, School of Medicine, Ankara, Turkey
4Department of Pathology, Gazi University, School of Medicine, Gazi, Turkey


Our two patients undergoing allogeneic bone marrow transplantation (AlloBMT) had both Hepatitis B virus (HBV) and graft-versus-host disease (GVHD). In the first patient, liver enzymes elevated three months after AlloBMT, and GVHD was diagnosed. Two weeks after the diagnosis of GVHD, HBsAg appeared in his serum. At that time, liver biopsy was not able to discriminate two disorders, but his sequential liver biopsies disclosed GVHD. Despite the patient was treated with cyclosporin A (CsA), he died for chronic GVHD. In contrast to the first patient, the second patient had HBsAg prior to GVHD. His liver enzymes deterioration was detected in the first month after AlloBMT, and reached the highest level in the third month while withdrawing CsA. In the fifth month he developed scleradermatous skin changes, and skin biopsy revealed chronic GVHD, whereas concurrent liver biopsy revealed chronic active hepatitis. This observation showed that immunosuppressive conditions such as GVHD or its prophylaxis may affect the appearance of liver pathology caused by HBV, which depends on the time of GVHD development, and the duration and depth of GVHD prophylaxis. Pathology & Oncology Research, Vol 5, Nr 3, 229-232, 1999

Key words: alloBMT; hepatitis B virus; graft versus-host disease

Received: Feb 5, 1999; accepted: May 17, 1999
Correspondence: Haluk KOÇ, Department of Hematology, Ankara University, School of Medicine, Ibni Sina Hospital Ankara 06100, Turkey; Tel: 90 3123103333 / 2121, Fax: 90 3123115474; E-mail:

Click here to get the full-text version in PDF!