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Screening the liver for chronic GVHD

Evaluation

Patient-reported symptoms and signs

  • Jaundice
  • Malaise
  • Itching

Clinical examination

Assess for hepatomegaly and right upper quadrant abdominal tenderness

Diagnostic testing 

  • Total and direct bilirubin
  • Alkaline phosphatase
  • ALT: Alanine aminotransferase
  • AST: Aspartate aminotransferase
  • GGT: Gamma glutamyl transpeptidase
  • 5'-NT: 5' nucleotidase
  • Liver biopsy may be needed in the absence of GVHD in another organ

Clinical manifestation

Clinical manifestation
Description
Hepatitis***
Rise in serum alanine aminotransferase,
> 2x upper limit of normal, with or without jaundice
Progressive cholestatic features***
The flow of bile from the liver is blocked; total bilirubin, alkaline phosphatase
> 2x upper limit of normal; elevated gamma-glutamyl transpeptidase, followed by jaundice

* Distinctive but insufficient alone to establish an unequivocal diagnosis of chronic GVHD without further testing or additional organ involvement.

** Rare, controversial, or non-specific features of chronic GVHD.

*** Common in both acute and chronic GVHD.