Clinical Value of Surveillance Biopsies in Pediatric Liver Transplantation.
Clinical Value of Surveillance Biopsies in Pediatric Liver Transplantation.
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DOI：
10.1002/lt.26399
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发表时间：
2022-05
影响因子：
4.6
通讯作者：
Emamaullee, Juliet
中科院分区：
文献类型：
--
作者：
Rocque, Brittany;Zaldana, Aaron;Weaver, Carly;Huang, Julia;Barbetta, Arianna;Shakhin, Victoria;Goldbeck, Cameron;Yanni, George;Zielsdorf, Shannon;Kwon, Yong;Etesami, Kambiz;Genyk, Yuri;Zhou, Shengmei;Kohli, Rohit;Emamaullee, Juliet
虽然小儿肝移植（LT）的结果在很好的长期结果，早期急性细胞排斥反应和晚期移植物纤维化的高发生率仍然存在。常规测定同种异体移植物酶可能不能可靠地检测排斥反应，识别免疫抑制最小化的候选者，或指示同种异体移植物纤维化。在这方面，监测活检（SB）可以提供有价值的信息，但其在儿科LT中的作用尚未完全确定。对来自一个高容量中心的236例儿童LT接受者进行了回顾性队列研究，以描述SB与有因活检（FCB）的风险和获益。研究人群为47.1%的男性和54.7%的西班牙裔，31%接受活体供体移植。我们的数据表明，SB组患者的移植结局（无排斥反应、移植物和患者存活率）优于FCB组或从未接受活检的患者。在236例患者的817例活检中，150例（18.4%）为SB。仅6例患者发生活检相关并发症，SB亚组中未观察到任何并发症。移植物生化血液检查不能准确预测活检时的排斥反应严重程度，天冬氨酸转氨酶受试者工作特征曲线下面积（AUROC）为0.66，丙氨酸转氨酶AUROC为0.65（极差预测），γ-谷氨酰转移酶AUROC为0.58（无预测）。SB在18.6%的活检中发现了亚临床排斥反应，而63.3%的SB有纤维化的证据。SB促使免疫抑制发生变化，包括剂量降低。我们的经验表明，SB在儿科LT中是安全的，提供了有关亚临床排斥事件的有价值的信息，并可以指导免疫抑制的管理，包括最小化。SB改善的结局可能是多因素的，可能与更有利的移植后早期病程和通过SB优化管理的可能效果有关。需要进一步的多中心研究来检查SB对儿科LT长期结局的作用。
Although pediatric liver transplantation (LT) results in excellent long-term outcomes, a high incidence of early acute cellular rejection and late graft fibrosis persists. Routine measurement of allograft enzymes may not reliably detect rejection episodes, identify candidates for immunosuppression minimization, or indicate allograft fibrosis. Surveillance biopsies (SBs) can provide valuable information in this regard, but their role in pediatric LT is not fully established. A retrospective cohort of 236 pediatric LT recipients from a high-volume center was studied to characterize the risks and benefits of SB versus for-cause biopsies (FCBs). The study population was 47.1% male and 54.7% Hispanic, and 31% received living donor grafts. Our data suggest that patients in the SB group had better transplant outcomes (rejection-free, graft, and patient survival) compared with patients who had FCBs or who never underwent biopsy. Among 817 biopsies obtained from 236 patients, 150 (18.4%) were SBs. Only 6 patients had a biopsy-related complication, and none were observed in the SB subset. Graft biochemical blood tests did not accurately predict rejection severity on biopsy, with aspartate aminotransferase area under the receiver operating characteristic curve (AUROC) 0.66, alanine aminotransferase AUROC 0.65 (very poor predictions), and gamma-glutamyltransferase AUROC 0.58 (no prediction). SBs identified subclinical rejection in 18.6% of biopsies, whereas 63.3% of SBs had evidence of fibrosis. SBs prompted changes in immunosuppression including dose reduction. Our experience suggests that SB in pediatric LT is safe, offers valuable information about subclinical rejection episodes, and can guide management of immunosuppression, including minimization. Improved outcomes with SB were likely multifactorial, potentially relating to a more favorable early posttransplant course and possible effect of management optimization through SB. Further multicenter studies are needed to examine the role of SBs on long-term outcomes in pediatric LT.
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作者：
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