Endothelial changes in cutaneous graft-versus-host disease: a comparison between HLA matched and mismatched recipients of bone marrow transplantation

Abstract

Histological features of endothelial and vascular changes seen in cell mediated immune reactions were evaluated in skin biopsies from 44 HLA matched and mismatched recipients of bone marrow transplantation. The mismatched group (n = 24) was further subdivided into 'D-mismatched' (n = 14) and 'AB-mismatched' (n = 10). All patients had clinical grade III and histological grade II graft-versus-host disease (GVHD). Comparison groups consisted of skin biopsies from 10 non-GVHD cases. Histological evidence of endothelial damage including perivascular factor VIII related antigen deposition was assessed and compared between the groups. The results showed that all patients post-transplant had evidence of a non-specific vascular response consisting mainly of a perivascular lymphocytic infiltrate, perivascular oedema and factor VIII related antigen extravasation. However, a significant difference between matched and mismatched patients who developed GVHD was the more frequent observation of perivascular nuclear dust in the HLA mismatched group (p less than 0.01) suggesting a greater degree of endothelial cell damage in these patients.