Protocol liver biopsies in stable long-term pediatric liver transplant recipients: risk or benefit?
Protocol liver biopsies in stable long-term pediatric liver transplant recipients: risk or benefit?
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DOI：
10.1097/meg.0000000000002006
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发表时间：
2021-12-01
影响因子：
2.1
通讯作者：
Lainka, Elke
中科院分区：
文献类型：
--
作者：
Ohlsson, Sinja;Kathemann, Simone;Lainka, Elke
背景 小儿肝移植 (LTX) 后的随访具有挑战性，需要进行完善，以延长移植物存活以及一般功能健康和患者的生活质量。个体免疫抑制治疗策略似乎发挥着关键作用。我们的目的是评估方案肝活检 (PLB) 作为儿科 LTX 后个性化随访的工具。患者和方法我们的回顾性分析评估了 2009 年至 2019 年间 LTX 后临床无症状儿科患者的 92 名 PLB。使用 Desmet 评分系统对组织学结果进行了表征。除了 PLB 之外，还评估了实验室参数、超声成像和瞬时弹性成像等其他后续工具。分析了发生纤维化或炎症的危险因素。结果PLB显示移植物纤维化（67.4％）和移植物炎症（47.8％）的患病率很高。与以后的时间点相比，移植后前 5 年内移植物炎症明显更频繁 (P = 0.0353*)。除传统超声外，使用瞬时弹性成像测量肝脏硬度与纤维化阶段相关（r = 0.567，P =
Background Follow-up after pediatric liver transplantation (LTX) is challenging and needs to be refined to extend graft survival as well as general functional health and patients' quality of life. Strategies towards individual immunosuppressive therapy seem to play a key role. Our aim was to evaluate protocol liver biopsies (PLB) as a tool in personalized follow up after pediatric LTX.Patients and methods Our retrospective analysis evaluates 92 PLB in clinically asymptomatic pediatric patients after LTX between 2009 and 2019. Histological findings were characterized using the Desmet scoring system. In addition to PLB, other follow-up tools like laboratory parameters, ultrasound imaging and transient elastography were evaluated. Risk factors for development of fibrosis or inflammation were analyzed.Results PLB revealed a high prevalence of graft fibrosis (67.4%) and graft inflammation (47.8%). Graft inflammation was significantly (P = 0.0353*) more frequent within the first 5 years after transplantation compared to later time points. Besides conventional ultrasound, the measurement of liver stiffness using transient elastography correlate with stage of fibrosis (r = 0.567, P =