Twenty-year protocol liver biopsies: Invasive but useful for the management of liver recipients

Sebagh, Mylène; Samuel, Didier; Antonini, Térésa; Coilly, Audrey; Esposti, Davide Degli; Roche, Bruno; Karam, Vincent; Santos, Alexandre Dos; Duclos‐Vallée, Jean‐Charles; Roque–Afonso, Anne–Marie; Ballot, Éric; Guettier, Catherine; Blandin, F.; Saliba, Faouzi; Azoulay, Daniel

doi:10.1016/j.jhep.2011.11.016

Cited by 52 publications

(38 citation statements)

References 24 publications

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“…It is indeed well known that normal liver function tests do not necessarily correlate with normal biopsy and viceversa. [9][10][11]32,33 These observations are also valid for other transplanted organs. 34,35 The relationship between CNI or steroids and posttransplant renal insufficiency (in 20%), 16 metabolic syndrome (in 40%) with its components diabetes, hypertension, dyslipidemia, obesity, and cardiovascular disease has been clearly identified.…”

Section: Discussionmentioning

confidence: 82%

“…29 Our study underlines the importance of routine liver biopsies as part of long-term follow-up of liver recipients. 11,12,32,33,47 Integration of clinical, biochemical, and pathologic information is necessary to fine-tune long-term IS treatment. Such an approach may be valuable to reduce the number of liver recipients going toward renal replacement therapy; to reduce the loss of functioning grafts due to lethal cardiovascular, infectious, and oncologic events; and to facilitate IS withdrawal in tolerance induction protocols.…”

Section: Discussionmentioning

confidence: 99%

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Is Minimal, [Almost] Steroid-Free Immunosuppression a Safe Approach in Adult Liver Transplantation? Long-term Outcome of a Prospective, Double Blind, Placebo-Controlled, Randomized, Investigator-Driven Study

Lerut

Pinheiro²,

Lai

et al. 2014

Annals of Surgery

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Is Minimal, [Almost] Steroid-Free Immunosuppression a Safe Approach in Adult Liver Transplantation? Long-term Outcome of a Prospective, Double Blind, Placebo-Controlled, Randomized, Investigator-Driven Study

Lerut

Pinheiro²,

Lai

et al. 2014

Annals of Surgery

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“…In fact, the use of protocol biopsies in the prior data may have led to earlier diagnoses of AR that were either clinically insignificant or treated earlier, leading to the reported better outcomes. 10, 11 Second, like our cohort, LT recipients are now older, sicker at the time of LT, and have more medical comorbidities making them more susceptible to the effects of rejection on graft function or to the increased immunosuppression required to treat rejection. Third, more relaxed monitoring for rejection and less aggressive treatment of rejection, may have contributed to chronic allograft injury in the more recent era.…”

Section: Discussionmentioning

confidence: 94%

Acute Rejection Increases Risk of Graft Failure and Death in Recent Liver Transplant Recipients

Levitsky

Goldberg

Smith

et al. 2017

Clinical Gastroenterology and Hepatology

192

162

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Background & Aims Acute rejection is detrimental to most transplanted solid organs, but is considered to be less of a consequence for transplanted livers. We evaluated risk factors for and outcomes after biopsy-proven acute rejection (BPAR) based on an analysis of a large national sample of recipients of liver transplants from living and deceased donors. Methods We analyzed data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) from 2003 through 2014 as the exploratory cohort and the Scientific Registry of Transplant Recipients (SRTR) from 2005 through 2013 as the validation cohort. We examined factors associated with time to first BPAR using multivariable Cox regression or discrete-survival analysis. Competing risks methods were used to compare causes of death and graft failure between recipients of living vs deceased donors. Results At least 1 BPAR episode occurred in 239/890 recipients in A2ALL (26.9%) and 7066/45,423 recipients in SRTR (15.6%). In each study, risk of rejection was significantly lower when livers came from biologically related living donors (A2ALL hazard ratio [HR], 0.57; 95% CI, 0.43–0.76 and SRTR HR, 0.78; 95% CI, 0.66–0.91) (P<.001) and higher in liver transplant recipients with primary biliary cirrhosis, of younger age, or with hepatitis C. In each study, BPAR was associated with significantly higher risks of graft failure and death. The risks were highest in the 12 month post-BPAR period in patients whose first episode occurred more than 1 year after liver transplantation. The HRs for graft failure were 6.79 in A2ALL (95% CI, 2.64–17.45) and 4.41 in SRTR (95% CI, 3.71–5.23). The HRs for death were 8.81 in A2ALL (95% CI, 3.37–23.04) and 3.94 in SRTR (95% CI, 3.22–4.83). In analyses of cause-specific mortality, associations were observed for liver-related (graft failure) causes of death but not for other causes. Conclusions Contrary to previous data, acute rejection after liver transplant is associated with significantly increased risk of graft failure, all-cause mortality and graft failure-related death. LDLT from a biologically related donor is associated with decreased risk of rejection.

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“…The overall mortality is associated with BMI and diabetes, with 50% of cases with BMI > 35 kg/m 2 dying within 1 year of transplantation [147] . Transplant failure (10% and 45% at 10 and 20 years, respectively [148] ) in obese patients is rarely associated with recurrent NASH cirrhosis ( ≈ 2%) [146] . …”

Section: Liver Transplantationmentioning

confidence: 99%

EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease

2016

Journal of Hepatology

3,582

1,817

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DefinitionNAFLD is characterised by excessive hepatic fat accumulation, associated with insulin resistance (IR), and defined by the presence of steatosis in >5% of hepatocytes according to histological analysis or by the proton density fat fraction (PDFF, providing a rough estimation of the volume fraction of fatty material in the liver) >5.6% assessed by proton magnetic resonance spectroscopy ( 1 H-MRS) or quantitative fat/water selective magnetic resonance imaging (MRI). NAFLD includes two pathologically distinct conditions with different prognoses: nonalcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH); the latter covers a wide spectrum of disease severity, including fibrosis, cirrhosis and hepatocellular carcinoma (HCC) ( table 2 ).The diagnosis of NAFLD requires exclusion of both secondary causes and a daily alcohol consumption ≥ 30 g for men and 20 g for women [1] . The relationship between alcohol and liver injury depends on several cofactors (type of alcoholic beverage, drinking patterns, duration of exposure, individual/genetic susceptibility), rendering simple quantitative thresholds at least partly arbitrary. Specifically, patients consuming moderate amounts of alcohol may be still predisposed to NAFLD if they have metabolic risk factors. Of note, the overall impact of metabolic risk factors on the occurrence of steatosis appears to be higher than that of alcohol in these patients [3] . The definitive diagnosis of NASH requires a liver biopsy. Recommendations• Patients with IR and/or metabolic risk factors (i.e., obesity or metabolic syndrome (MetS)) should undergo diagnostic procedures for the diagnosis of NAFLD, which relies on the demonstration of excessive liver fat (A1) • Individuals with steatosis should be screened for secondary causes of NAFLD, including a careful assessment of alcohol intake. The interaction between moderate amounts of alcohol and metabolic factors in fatty liver should always be considered (A1) • Other chronic liver diseases, that may coexist with NAFLD, should be identified as this might result in more severe liver injury (B1) Prevalence and IncidenceNAFLD is the most common liver disorder in Western countries, affecting 17-46% of adults, with differences according to the diagnostic method, age, sex and ethnicity [4] . It parallels the prevalence of MetS and its components, which also increases the risk of more advanced disease, both in adults and in children. NAFLD is also present in 7% of normalweight (lean) persons [5] , more frequently in females, at a younger age and with normal liver enzymes. Their liver disease may nonetheless be progressive [6] .NAFLD incidence has rarely been measured. It was 20-86/1,000 person-years based on elevated liver enzymes and/or on ultrasound (US), and 34/1,000 per year by 1 H-MRS [7] . The need for NAFLD screening in the community has been questioned given the high direct and indirect costs of testing, the low predictive value of non-invasive tests, the risks of liver biopsy and the lack of effective treatments [8] . Ho...

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Twenty-year protocol liver biopsies: Invasive but useful for the management of liver recipients

Cited by 52 publications

References 24 publications

Is Minimal, [Almost] Steroid-Free Immunosuppression a Safe Approach in Adult Liver Transplantation? Long-term Outcome of a Prospective, Double Blind, Placebo-Controlled, Randomized, Investigator-Driven Study

Is Minimal, [Almost] Steroid-Free Immunosuppression a Safe Approach in Adult Liver Transplantation? Long-term Outcome of a Prospective, Double Blind, Placebo-Controlled, Randomized, Investigator-Driven Study

Acute Rejection Increases Risk of Graft Failure and Death in Recent Liver Transplant Recipients

EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease

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