The use of laparoscopic liver biopsies in pediatric patients with hepatic dysfunction following allogeneic hematopoietic stem cell transplantation

Abstract

Summary:Hepatic dysfunction following hematopoietic stem cell transplantation (HSCT) is common, but making the correct diagnosis can be challenging. Liver biopsies can serve as an important diagnostic tool when the etiology cannot be clearly determined by laboratory data, physical examination, and imaging studies. We reviewed 12 consecutive pediatric patients (seven males, five females, age 9-23 years) who received allogeneic HSCT and underwent a laparoscopicguided liver biopsy for hepatic dysfunction of unknown etiology from 1998 to 2005. Biopsies were performed using a single-port technique with a 16 or 18 gauge, spring-loaded biopsy gun. The time from HSCT to biopsy ranged from 31 days to 821 days (median 92 days). No intra-or postoperative complications were observed. The initial clinical diagnosis was confirmed in seven patients, whereas the initial working diagnosis was inaccurate in the remaining five patients. Our results suggest that laparoscopic-guided liver biopsy is an informative and safe procedure in pediatric HSCT recipients; this approach helped delineate the true cause of hepatic dysfunction and changed our therapeutic approach in approximately 40% of the patients reviewed. While the safety record at our institution appears promising, a larger multi-institutional study would be necessary to more accurately describe the overall efficacy of this procedure in pediatric HSCT patients. Bone Marrow Transplantation (2005) 36, 891-896.

The role of liver biopsy in the workup of liver dysfunction late after SCT: is the role of iron overload underestimated?

“…3,16 Percutaneous liver biopsy is an invasive but relatively safe diagnostic procedure in patients with normal hemostasis tests and platelet counts above 50 Â 10 9 per liter. 8 The percutaneous route was preferred in our patient cohort, as majority of the biopsies were obtained in the late post transplantation period when platelet counts were normal. A complication rate below 5% with a histopathologic diagnostic yield of 91.7% in our patient cohort indicates that percutaneous liver biopsy is a relatively safe and effective diagnostic procedure in the late stages of HSCT.…”

“…[3][4][5][6][7][8][9][10][11][12] Hepatic toxicity due to chemotherapy and radiotherapy, SOS/VOD, total parenteral nutrition, GVHD, sepsis, reactivation of viral hepatitis, CMV and IO are the most common causes of the abnormalities in liver function tests (LFTs). 6,7,[12][13][14][15] Although the cause of the hepatic dysfunction is usually diagnosed by clinical and laboratory features, liver biopsy is required in patients with uncertain and/or overlapping etiology.…”

“…Although a very valuable diagnostic tool particularly in cases with uncertain and overlapping clinical features, liver biopsy is an invasive procedure with a significant complication rate. 8 There is an increased rate of hemorrhagic complications due to thrombocytopenia during the early post transplant period, during which time transjugular biopsy is the method of choice. 8,9 We retrospectively reviewed the medical records of 20 patients in whom liver biopsy was required to clarify the cause of elevated liver enzymes post transplantation.…”

“…8 There is an increased rate of hemorrhagic complications due to thrombocytopenia during the early post transplant period, during which time transjugular biopsy is the method of choice. 8,9 We retrospectively reviewed the medical records of 20 patients in whom liver biopsy was required to clarify the cause of elevated liver enzymes post transplantation. The impact of liver biopsy in the management of liver dysfunction in these 20 HSCT recipients was also evaluated.…”

“…The major causes of liver dysfunction in the early post transplant period are chemotherapy, radiotherapy, sinusoidal obstruction syndrome/venoocclusive disease (SOS/VOD), infections (hepatitis lenta) and drugs, whereas GVHD, iron overload (IO) and reactivation of viral infections such as CMV) and hepatitis B and C account for most of the cases of liver dysfunction in the intermediate and late periods. [3][4][5][6][7][8] Diagnosis usually depends on the clinical and laboratory features and exclusion of possible etiologic factors. Reactivation of virus infections and acute viral hepatitis are diagnosed with molecular viral tests, and SOS/VOD and GVHD are usually diagnosed clinically.…”