US-Guided Percutaneous Liver Biopsy in Pediatric Liver Transplant Recipients
US-Guided Percutaneous Liver Biopsy in Pediatric Liver Transplant Recipients
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DOI：
10.1097/mpg.0000000000000328
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发表时间：
2014-06-01
影响因子：
2.9
通讯作者：
Luca, Angelo
中科院分区：
文献类型：
--
作者：
Mandal, Soma;Miraglia, Roberto;Luca, Angelo
目的：本研究评估超声（US）引导下经皮肝穿刺活检（PLB）在小儿肝移植受者的安全性，描述了根据早期（12个月）和晚期（>12个月）移植后的病理结果，并分析肝功能检查（LFT）和多普勒超声变量在确定这些结果的价值。方法：在2005年3月至2012年5月期间，对85例小儿肝移植患者（平均年龄75岁，范围：6个月至18岁）进行了219次US引导下PLB回顾性评价。早期（n=92，42%）和晚期（n=127，58%）移植后活检的1天内进行多普勒超声和LFT评估（包括总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、谷氨酰转移酶、碱性磷酸酶）。早期与晚期活检结果分别包括：胆汁淤积：36% vs 18%（P=0.003），微小变化16% vs 24%（无显著性[NS]），急性排斥反应13% vs 5%（P=0.027），炎性疾病15%对15%（NS），不确定性急性排斥反应11%对7%（NS），慢性排斥反应4%对14%（NS（P=0.017），纤维化疾病4%对12%（NS），和其他0%对5%（NS）。无论是LFT还是US变量与病理outcome.Conclusions：并发症的发生率在儿科患者超声引导下肝活检后是低的。移植后早期和晚期肝活检存在一系列病理结果。LFT和多普勒超声结果不是病理结果的预测因子。
Objectives:The present study assesses the safety of ultrasound (US)-guided percutaneous liver biopsies (PLBs) within pediatric liver allograft recipients, describes the pathological results according to early (12 months) and late (>12 months) posttransplantation periods, and analyzes the value of liver function tests (LFTs) and Doppler US variables in determining these results.Methods:A total of 219 US-guided PLBs in 85 pediatric patients with liver transplant (mean age 75 years, range: 6 months to 18 years) performed between March 2005 and May 2012 were retrospectively evaluated at a single institution. Doppler US and LFT evaluation (including total bilirubin, alanine aminotransferase, aspartate aminotransferase, -glutamyl transferase, alkaline phosphatase) occurred within 1 day of early (n=92, 42%) and late term (n=127, 58%) posttransplantation biopsies.Results:The rate of major complications (hemorrhage requiring blood transfusion) was 0.91% (n=2). The early versus late term biopsy results, respectively, included: cholestasis at 36% versus 18% (P=0.003), minimal changes 16% versus 24% (not significant [NS]), acute rejection 13% versus 5% (P=0.027), inflammatory diseases 15% versus 15% (NS), indeterminate acute rejection 11% versus 7% (NS), chronic rejection 4% versus 14% (P=0.017), fibrotic diseases 4% versus 12% (NS), and other 0% versus 5% (NS). Neither LFT nor US variables were correlated with pathological outcomes.Conclusions:The rate of complications in pediatric patients after US-guided liver biopsy is low. A range of pathological results exists between early and late posttransplantation liver biopsies. LFT and Doppler US findings are not predictors of pathological results.