Posttransplant biopsy risk for stable long-term pediatric liver transplant recipients: 451 percutaneous biopsies from two multicenter immunosuppression withdrawal trials

Abstract

Although liver biopsy is the gold standard for assessing allograft health, its attendant risk has deterred its use in routine monitoring of stable liver transplant recipients during long‐term follow‐up. We utilized prospectively collected data on adverse events from 2 clinical trials of immunosuppression withdrawal to quantify the risk of liver biopsy in pediatric liver transplant recipients. The trials included 451 liver biopsies in 179 children. No biopsies led to bleeding requiring transfusion or intervention, suggesting a clinically significant bleeding risk of <0.8%. Complications were reported in 5.5% of biopsies (95% CI 3.6%‐8.1%): 5.8% (21/363) of protocol biopsies and 4.5% (4/88) of for‐cause biopsies (P = .80). Mild complications occurred in 1.8% of biopsies, moderate in 1.8%, and severe in 2.0%. The majority of complications (89%) resolved within 1 week. Six of 9 (67%) severe complications were related to biliary issues; 5 were episodes of cholangitis. Biopsy‐related cholangitis occurred only in children with underlying biliary strictures. Overall, biopsy‐related complications were infrequent and resolved quickly. Severe complications were rare, with occult biliary stricture as the dominant driver. Our study provides evidence for clinicians who are considering the risk vs benefit of surveillance liver biopsies in pediatric liver transplant recipients.

Major complications after percutaneous biopsy of native or transplanted liver in pediatric patients: a nationwide inpatient database study in Japan

“…A previous study using 451 pediatric patients with transplanted liver under stable conditions (i.e., without high doses of corticosteroids) reported no major bleeding complication [ 23 ]. Another previous study identified younger age as a possible risk factor in pediatric patients with native and transplanted liver [ 7 ].…”

Barriers to ideal outcomes after pediatric liver transplantation

“…38 Liver biopsies suffer from variable interpretation and sampling error, while imaging studies are insensitive. 38,39 Clinical trials are needed to determine predictors of successful immunosuppression withdrawal to allow for personalization of medication regimens.…”

“…Chronic allograft injury, both inflammation and/or fibrosis, was reported in a multicenter cohort of stable, long‐term pediatric LT recipients with consistently normal results from liver tests . Complications following protocol liver biopsies performed in post‐pediatric LT recipients were infrequent and resolved quickly, with biopsy‐related cholangitis occurring only in those patients with underlying biliary strictures . Liver biopsies suffer from variable interpretation and sampling error, while imaging studies are insensitive .…”

“…Complications following protocol liver biopsies performed in post‐pediatric LT recipients were infrequent and resolved quickly, with biopsy‐related cholangitis occurring only in those patients with underlying biliary strictures . Liver biopsies suffer from variable interpretation and sampling error, while imaging studies are insensitive . Clinical trials are needed to determine predictors of successful immunosuppression withdrawal to allow for personalization of medication regimens.…”

Prophylactic Strategy Against De Novo Hepatitis B Virus Infection for Pediatric Recipients Who Receive Hepatitis B Core Antibody–Positive Liver Grafts

“…The compromised immune system of recipients is a risk factor for developing tumors and viral infections that negatively affect the life quality and recipient survival. ( 4 )…”