Histological findings in protocol biopsies following pediatric liver transplant: Low incidence of abnormalities at 5 years

Pediatric Transplantation
Amin SheikhHelen M Evans

Abstract

Histological abnormalities, including chronic hepatitis, fibrosis, and steatosis, are increasingly reported in liver biopsies of children after LT. These changes may be progressive and represent a form of rejection. Liver biochemistry is often initially normal. Our LT program began in 2002, utilizing tacrolimus and low-dose steroids for the first year post-LT. Patients undergo a protocol biopsy at 1 year post-LT prior to stopping steroids, then at 5 years and every 5 years thereafter. Target tacrolimus levels are 5-8 μg/L and 3-5 μg/L after 3 and 12 months, respectively. Between 2002 and 2009, 51 LT were performed; 50 (98%) and 49 (96%) patients survived for 1 and 5 years, respectively. A total of 43 patients (median age at LT 2.3 years) underwent a protocol biopsy at 1 year (16 male; median time post-LT 12.5 months), and 44 (20 male; median time post-LT 5.1 years) at 5 years. By 5 years, 3 had transferred to adult services; 1 was re-transplanted for graft failure and 1 moved overseas. Biopsies were reviewed by 2 pathologists. Most patients (31/44) were on tacrolimus monotherapy at 5 years. At 1 and 5 years, 29 of 43 (67.5%) and 31 of 44 (71%) biopsies were normal, respectively. Two of 44 had chronic allograft hepatitis at 5 ye...Continue Reading

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Citations

Jun 17, 2020·World Journal of Gastroenterology : WJG·Mathew GeorgeTimucin Taner
Aug 19, 2020·Journal of Pediatric Gastroenterology and Nutrition·Emma Monique SaelensRuth M L De Bruyne
Jun 25, 2021·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Roberta AngelicoPaola Francalanci
Aug 28, 2021·Children·Małgorzata Markiewicz-KijewskaHor Ismail
Sep 15, 2021·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Wesley DixonSandy Feng

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