“Safety and utility of percutaneous liver biopsy in hematopoietic stem cell transplant pediatric recipients: a retrospective study”

Abstract

BackgroundLiver biopsies in pediatric hematopoietic stem cell transplantation (HSCT) patients are as and effective when performed at bedside in the Bone Marrow Transplant Unit (BMTU) than in the Day Surgery Unit (DSU), with better patient compliance and lower emotional distress for these children.MethodsThe study group consisted of 45 children who underwent allogeneic HSCT. We reviewed 68 liver biopsies performed between April 2006 and September 2015. 12 (17.6 %) biopsies were performed in the DSU and 56 (82.3 %) in the BMTU; nine (13.2 %) prior to HSCT and 59 (86.7 %) after HSCT. Pre-procedural behavioral status (subjective score) was evaluated by pediatric transplant physicians by filling in a questionnaire employing a three-point scale: “calm and cooperative”, “agitated and non-cooperative” or “frightened and suffering”. Objective score was obtained measuring patient’s heart rate before the procedure and comparing it with mean heart rate.ResultsPatients who underwent the procedure at the BMTU experienced less emotional distress than those who underwent it in the DSU: 58.3 % of patients treated at the DSU were agitated as compared with 16.1 % of those treated at the BMTU (p < 0.01). Among the 59 biopsies performed after HSCT, 41 (69.5 %) were taken from symptomatic patients for a diagnostic purpose and 18 (30.5 %) in asymptomatic ones in order to rule out hepatic GVHD. Among these 18 procedures, GVHD was diagnosed in 16 (88.9 %) cases. Minor complications occurred in about 17 % of procedures (12 biopsies), at a rate of 25 % for the DSU location compared with 16 % for the BMTU location. Only two major complications were reported, one in the DSU and one in the BMTU.ConclusionLiver biopsy performed at bedside in HSCT patients does not carry a higher risk of adverse events than the same procedure performed in the DSU and has lower emotional distress associated with better patient compliance, thus contributing significantly to a higher standard of care.

Utility and Safety of Liver Biopsy in Patients with Undetermined Liver Blood Test Anomalies after Allogeneic Hematopoietic Stem Cell Transplantation: A Monocentric Retrospective Cohort Study

“…Four transjugular biopsies induced hemorrhage, and 2 children had to be admitted to intensive care units [46]. By contrast, Maximova et al [48] performed a study focusing on a child's feeling during liver biopsy procedure, comparing hospitalization in a bone marrow transplantation unit or day surgery unit. In their study, percutaneous liver biopsies were quite safe, with only 2 major complications out of 68 biopsies (3%).…”

In vivo imaging of nanoparticle-labeled CAR T cells

“…Strategies used by clinical investigators to assess the activity of infused CAR T cells consist of flow cytometry, immunohistochemistry, and qPCR of peripheral blood samples or biopsies of sites of CAR T-cell activity including bone marrow, tumors, and lymph nodes ( 9 , 10 ). While they provide suitable information, flow cytometry measurements of the expression of the CAR gene in circulating T cells represents the response in the periphery and not the tumor site ( 11 ), and repeated invasive biopsies are not practical in most clinical trials ( 12 ).…”

Liver Graft‐Versus‐Host Disease is associated with poor survival among allogeneic hematopoietic stem cell transplant recipients

“…Conversely, previous reports have noted severe hemorrhages, subcapsular bleeding, cardiac arrythmia, ICU admissions and procedure related deaths . Another study reported 3% complication rate following percutaneous liver biopsies …”