Twenty-year protocol liver biopsies: Invasive but useful for the management of liver recipients

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• 作者：Mylè ; ne Sebagh¹ ; ³ ; ⁴ ; ^{mylene.sebagh@pbr.aphp.fr} ; Didier Samuel² ; ³ ; ⁴ ; Teresa Maria Antonini² ; Audrey Coilly² ; Davide Degli Esposti⁵ ; Bruno Roche² ; ³ ; ⁴ ; Vincent Karam² ; Alexandre Dos Santos³ ; ⁴ ; Jean-Charles Duclos-Vallé ; e² ; ³ ; ⁴ ; Anne-Marie Roque-Afonso³ ; ⁴ ; ⁶ ; Eric Ballot³ ; ⁴ ; ⁷ ; Catherine Guettier¹ ; ³ ; ⁴ ; Fré ; dé ; rique Blandin² ; Faouzi Saliba² ; ³ ; ⁴ ; Daniel Azoulay²
• 关键词：LT ; liver transplantation ; LB ; liver biopsy ; CH ; chronic hepatitis ; HCV ; hepatitis C virus ; HBV ; hepatitis B virus ; HDV ; hepatitis D virus ; LFTs ; liver function tests ; GGT ; 纬 glutamyl transferase ; ALP ; alkaline phosphatase ; AST ; aspartate aminotransferas
• 刊名：Journal of Hepatology
• 出版年：2012
• 期刊代码：162_01688278
• 类别：med
• 出版时间：April, 2012
• 卷：56
• 期：4
• 页码：840-847
• 文件大小：554 K

摘要

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Background & Aims

Most liver transplant centres have discontinued the practice of protocol liver biopsies (LB), mainly because of the perceived lack of therapeutic benefit. This study aimed to examine the usefulness of 20-year LBs.

Methods

Ten, 15, and 20-year protocol LBs from 147 patients surviving for >20 years were reviewed. Twenty-year biopsy findings were correlated with clinical data.

Results

Twenty-year-biopsy patients (N = 91) and 20-year-non-biopsy patients (N = 56) were similar in terms of transplant data, adverse events, and liver function tests (LFTs). Twenty-year LBs revealed a 90%prevalence of abnormalities, among which viral chronic hepatitis (VCH) was the most common (46%). Between 15 and 20 years, hepatic structural abnormalities were the only disorder to increase (p = 0.008). An individual progression of abnormalities occurred in 56%of patients. At 20 years, the negative and positive predictive values (PV) of LFTs with respect to histological abnormalities were 95%and 18%, respectively; in VCH, Fibrotest and transient elastography displayed poor discriminative ability for fibrosis (80%and 81%discordance, respectively), but were satisfactory regarding significant fibrosis (negative PV of 77.7%and 80%, respectively). A decrease in immunosuppression was less frequent (14/91 vs. 20/56, p = 0.008) while an increase was more common (15/91 vs. 2/56, p = 0.017) in 20-year-biopsy patients than in non-biopsy patients. Antiviral therapy was administered in seven of the 20-year biopsy patients, but in none of the non-biopsy patients (p = 0.04).

Conclusions

Twenty-year LBs provided important histological information on graft function that was available to a limited degree from LFTs and non-invasive markers. They exerted an impact on immunosuppressive and antiviral therapies.