Protocol biopsies in liver transplantation

Burroughs, Andrew K.; Patch, David; Stigliano, Rosa; Cecilioni, L.

doi:10.1002/lt.500090723

Cited by 6 publications

(4 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We evaluated 2 different immunosuppressive regimens in liver transplant recipients with HCV cirrhosis, with respect to the frequency and severity of cellular rejection, using a schedule of protocol liver biopsies, which is the gold standard for the diagnosis of cellular rejection (26). The first 3 months after transplant, rather than just the first 6 weeks were evaluated, because this longer period usually encompasses most acute rejection episodes (9, 27) and during this time there should be far less histological confusion with recurrent HCV (28).…”

Section: Discussionmentioning

confidence: 99%

Rejection rates in a randomised trial of tacrolimus monotherapy versus triple therapy in liver transplant recipients with hepatitis C virus cirrhosis

Samonakis

Mela

Quaglia

et al. 2006

Transplant Infectious Dis

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Rejection rates in a randomised trial of tacrolimus monotherapy versus triple therapy in liver transplant recipients with hepatitis C virus cirrhosis

Samonakis

Mela

Quaglia

et al. 2006

Transplant Infectious Dis

View full text Add to dashboard Cite

show abstract

“…Although the clinical course is favourable for most patients, and successful response to boluses of steroids occurs in up to 80% of patients , several episodes of steroid‐resistant ACR or the late onset (defined as an episode after 6 months) may increase the risk of chronic rejection and graft loss . In the past, some liver transplant institutions implemented protocol biopsies early after LT to detect and treat ACR . However, the potential harm of liver biopsy and the reduced impact of ACR under the current immunosuppressive regimens have discouraged this strategy.…”

Section: Introductionmentioning

confidence: 99%

Lack of agreement for defining ‘clinical suspicion of rejection’ in liver transplantation: a model to select candidates for liver biopsy

et al. 2015

Self Cite

View full text Add to dashboard Cite

SummaryThe gold standard to diagnose acute cellular rejection (ACR) after liver transplantation (LT) is histological evaluation, but there is no consensus to select patients for liver biopsy. We aimed to evaluate the agreement among clinicians to select candidates for liver biopsy early after LT. From a protocol biopsy population (n = 690), we randomly selected 100 LT patients in whom the biopsy was taken 7-10 days after LT. The clinical information between LT and protocol biopsy was given to nine clinicians from three transplant centres who decided whether a liver biopsy was needed. The agreement among clinicians to select candidates for liver biopsy was poor: j = 0.06-0.62, being j < 0.40 in 76% of comparisons. The concordance between indication for liver biopsy and moderate-severe ACR in the protocol biopsy was j < 0.30 in all cases. A multivariate model based on the product age-by-MELD (OR = 0.81; P = 0.013), delta eosinophils (OR = 1.5; P = 0.002) and mean tacrolimus trough concentrations <6 ng/ml within the prior 4 days (OR = 11.4; P = 0.047) had an AUROC = 0.84 to diagnose moderatesevere histological ACR. In conclusion, the agreement among clinicians to select patients for liver biopsy is very poor. If further validated the proposed model would provide an objective method to select candidates for liver biopsy after LT.

show abstract

“…The clinical significance of ACR and its interpretation have changed over the decades. ACR had a prominent role, such that some centres implemented routine protocol biopsies to detect and treat rejection promptly [5]. Currently many centres only perform liver biopsies if there is significant derangement of liver function tests, and will treat possible rejection empirically also considering that complications can occur, even with a transjugular biopsy [6].…”

Section: Introductionmentioning

confidence: 99%

Predicting severity and clinical course of acute rejection after liver transplantation using blood eosinophil count

Rodríguez‐Perálvarez¹,

Germani²,

Tsochatzis³

et al. 2012

Transplant International

View full text Add to dashboard Cite

Summary Acute cellular rejection remains an important source of morbidity after liver transplantation, particularly if rejection is moderate or severe, as this usually is treated. Currently liver biopsies are seldom performed, so diagnostic noninvasive markers would be useful. We evaluated 690 consecutive first liver transplant patients to assess whether peripheral eosinophilia could predict moderate‐severe rejection and its course. A protocol biopsy was performed 6 ± 2.5 days after transplant. A second biopsy was taken 6.1 ± 2 days after the first in 487 patients to assess histological improvement. Liver function tests, peripheral eosinophil count and changes between first and second biopsy, were evaluated using logistic regression. Histological rejection was present in 532 patients (77.1%), with moderate (30.6%) and severe rejection (3.9%). Peripheral eosinophil count was strongly associated with moderate‐severe rejection (OR = 2.15; P = 0.007), although the area under ROC curve (AUROC) was 0.58. On second biopsy, rejection improved in 119 (24.4%) patients. The delta in eosinophil count between the first and second biopsies was the only independent predictor of histological improvement (OR = 3.12; P = 0.001), irrespective of whether bolus steroids were used (OR = 2.77; P = 0.004); AUROC was 0.72. Peripheral eosinophilia is not sufficiently predictive of moderate‐severe histological rejection. However the changes in eosinophil count over time can accurately predict the histological resolution of rejection.

show abstract

Protocol biopsies in liver transplantation

Cited by 6 publications

References 8 publications

Rejection rates in a randomised trial of tacrolimus monotherapy versus triple therapy in liver transplant recipients with hepatitis C virus cirrhosis

Rejection rates in a randomised trial of tacrolimus monotherapy versus triple therapy in liver transplant recipients with hepatitis C virus cirrhosis

Lack of agreement for defining ‘clinical suspicion of rejection’ in liver transplantation: a model to select candidates for liver biopsy

Predicting severity and clinical course of acute rejection after liver transplantation using blood eosinophil count

Contact Info

Product

Resources

About