Graft histology characteristics in long-term survivors of pediatric liver transplantation

Abstract

The factors that influence the long‐term histological outcome of transplanted liver allografts in children are not yet fully understood, and the role of surveillance biopsies in patients with normal graft function remains controversial. The aims of this study were to describe the long‐term graft histology of pediatric liver transplant recipients surviving at least 3 years and to analyze factors correlating with long‐term histological outcome. Histological slides of 63 long‐term liver transplant recipients were assessed for inflammation and fibrosis. The histological findings were correlated with clinical, biochemical, serological, and radiological findings. A significant proportion of biopsies from these patients showed some type of histological abnormalities, with fibrosis being observed in 61 (97%) patients. Duration of transplantation of >6 years and ≥grade 2 inflammation were significantly associated with advanced fibrosis. We could not identify any correlation between ≥stage 3 fibrosis and donor age, cold and warm ischemia time, history of de novo autoimmune hepatitis, hepatic artery thrombosis, chronic rejection, or alanine aminotransferase, aspartate aminotransferase, and gamma‐glutamyl transferase values. In conclusion, liver fibrosis appears to be a common finding in long‐term pediatric liver transplant survivors. The cause of this fibrosis is uncertain, and normal alanine aminotransferase, aspartate aminotransferase, and gamma‐glutamyl transferase levels do not exclude the presence of significant fibrosis. Liver Transpl 14:1582–1587, 2008. © 2008 AASLD.

Trasplante hepático infantil. Resultados a largo plazo

“…En Chicago efectuaron un estudio conjunto de biopsias realizadas a niños con problemas clínicos del injerto y a un grupo de niños que aceptaron biopsia habitual a pesar de mostrar función hepática normal 9 . En Groningen analizaron las biopsias al 10. o año de seguimiento en 55 casos, pero su pauta inmunosupresora había sido peculiar, sin emplear inhibidores de calcineurina a partir del 2. o año, la mayoría solamente recibían esteroide y azatioprina 10 .…”

Acoustic radiation force impulse (ARFI) elastography compared with biopsy for evaluating hepatic fibrosis after liver transplantation: a cross-sectional diagnostic study

“…[1][2][3][4] Nonetheless, histological changes in transplanted livers can occur subclinically and progressively even in asymptomatic patients and without significant laboratory alterations. [3][4][5][6] Liver biopsy is currently the gold standard for histological evaluation of the liver. [7][8][9][10] However, it is invasive and poses a risk of complications with morbidity around 0.3 to 0.6% and mortality of 0.05%, besides hospitalization of at least 6-18 hours.…”

“…3,4 The main histological alterations observed in anatomopathological evaluations on biopsies on transplanted livers involve inflammation and fibrosis. 6 However, the degree of fibrosis may be underestimated in situations of inadequate sampling, given that the volume of the sample evaluated in the biopsy is only 1/50,000 of the organ. There have been reports of discrepancies in both inter and intraobserver histological analyses, at estimated rates of 10 to 30% of the cases.…”

Idiopathic Post Liver-Transplant Hepatitis Remains Obscure with Respect to Its Etiology and Relationship with Immunosuppressiona

“…This entity, referred to as idiopathic post-transplant hepatitis (IPTH), is mostly characterized by mild fibrosis, necro-inflammatory activity and near-normal liver tests (LT). In most long-term follow-up studies, it has been seen that IPTH usually has a benign outcome [1,2,7,8] , although some studies have produced controversial evidence, including the development of late graft fibrosis [9][10][11][12] . IPTH is therefore considered as a CH form of rejection [10,11,13,14] , an atypical form of de novo AIH, a recurrent disease which lacks classic histological abnormalities or CH due to a possibly unknown viral agent [2,7,8,15] .…”