US‐Guided Percutaneous Liver Biopsy in Pediatric Liver Transplant Recipients

Mandal, Soma; Miraglia, Roberto; Maruzzelli, Luigi; Liotta, Rosa; Tuzzolino, Fabio; Spada, Marco; Riva, Silvia; Luca, Angelo

doi:10.1097/mpg.0000000000000328

Cited by 16 publications

(14 citation statements)

References 35 publications

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“…Antagonism of FXR may promote cholestasis through all these mechanisms 4 , 10 . In line with earlier studies, 6 – 9 , 12 – 15 we found serum and liver PSs to correlate with GT, a sensitive marker of cholestasis and biliary injury 32 . In PN‐dependent patients, liver campesterol and stigmasterol also correlated with liver fibrosis.…”

Section: Discussionsupporting

confidence: 91%

Parenteral Plant Sterols Accumulate in the Liver Reflecting Their Increased Serum Levels and Portal Inflammation in Children With Intestinal Failure

Hukkinen

Mutanen

Nissinen

et al. 2016

J Parenter Enteral Nutr

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Section: Discussionsupporting

confidence: 91%

Parenteral Plant Sterols Accumulate in the Liver Reflecting Their Increased Serum Levels and Portal Inflammation in Children With Intestinal Failure

Hukkinen

Mutanen

Nissinen

et al. 2016

J Parenter Enteral Nutr

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“…International Normalized Ratio is a valuable biomarker for prognostication and determination of organ allocation; however it is inadequate for the measurement of bleeding risk. In children undergoing liver biopsy, hemorrhagic complications can occur in 0.91-4.2% of cases and coagulopathy markers do not predict bleeding complications (36,37).…”

Section: Limitation Of Standard Hemostatic Testsmentioning

confidence: 99%

Hemostatic Balance in Pediatric Acute Liver Failure: Epidemiology of Bleeding and Thrombosis, Physiology, and Current Strategies

2020

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Pediatric Acute Liver Failure (PALF) is a rapidly progressive clinical syndrome encountered in the pediatric ICU which may rapidly progress to multi-organ dysfunction, and on occasion to life threatening cerebral edema and hemorrhage. Pediatric Acute Liver Failure is defined as severe acute hepatic dysfunction accompanied by encephalopathy and liver-based coagulopathy defined as prolongation of International Normalized Ratio (INR) >1.5. However, coagulopathy in PALF is complex and warrants a deeper understanding of the hemostatic balance in acute liver failure. Although an INR value of >1.5 is accepted as the evidence of coagulopathy and has historically been viewed as a prognostic factor of PALF, it may not accurately reflect the bleeding risk in PALF since it only measures procoagulant factors. Paradoxically, despite the prolongation of INR, bleeding risk is lower than expected (around 5%). This is due to “rebalanced hemostasis” due to concurrent changes in procoagulant, anticoagulant and fibrinolytic systems. Since the liver is involved in both procoagulant (Factors II, V, IX, XI, and fibrinogen) and anticoagulant (Protein C, Protein S, and antithrombin) protein synthesis, PALF results in “rebalanced hemostasis” or even may shift toward a hypercoagulable state. In addition to rebalanced coagulation there is altered platelet production due to decreased thrombopoietin production by liver, increased von Willebrand factor from low grade endothelial cell activation, and hyperfibrinolysis and dysfibrinogenemia from altered synthetic liver dysfunction. All these alterations contribute to the multifactorial nature of coagulopathy in PALF. Over exuberant use of prophylactic blood products in patients with PALF may contribute to morbidities such as fluid overload, transfusion-associated lung injury, and increased thrombosis risk. It is essential to use caution when using INR values for plasma and factor administration. In this review we will summarize the complexity of coagulation in PALF, explore “rebalanced hemostasis,” and discuss the limitations of current coagulation tests. We will also review strategies to accurately diagnose the coagulopathy of PALF and targeted therapies.

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“…Previous reports of liver biopsy risk in children are predominantly retrospective, small or single center, and not transplant specific . In contrast, this report is based on prospectively collected data from two multicenter, immunosuppression withdrawal trials (WISPR [NCT00320606] and iWITH [NCT01638559]).…”

Section: Introductionmentioning

confidence: 99%

Posttransplant biopsy risk for stable long-term pediatric liver transplant recipients: 451 percutaneous biopsies from two multicenter immunosuppression withdrawal trials

Perito

Martínez

Turmelle

et al. 2019

American Journal of Transplantation

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Although liver biopsy is the gold standard for assessing allograft health, its attendant risk has deterred its use in routine monitoring of stable liver transplant recipients during long‐term follow‐up. We utilized prospectively collected data on adverse events from 2 clinical trials of immunosuppression withdrawal to quantify the risk of liver biopsy in pediatric liver transplant recipients. The trials included 451 liver biopsies in 179 children. No biopsies led to bleeding requiring transfusion or intervention, suggesting a clinically significant bleeding risk of <0.8%. Complications were reported in 5.5% of biopsies (95% CI 3.6%‐8.1%): 5.8% (21/363) of protocol biopsies and 4.5% (4/88) of for‐cause biopsies (P = .80). Mild complications occurred in 1.8% of biopsies, moderate in 1.8%, and severe in 2.0%. The majority of complications (89%) resolved within 1 week. Six of 9 (67%) severe complications were related to biliary issues; 5 were episodes of cholangitis. Biopsy‐related cholangitis occurred only in children with underlying biliary strictures. Overall, biopsy‐related complications were infrequent and resolved quickly. Severe complications were rare, with occult biliary stricture as the dominant driver. Our study provides evidence for clinicians who are considering the risk vs benefit of surveillance liver biopsies in pediatric liver transplant recipients.

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US‐Guided Percutaneous Liver Biopsy in Pediatric Liver Transplant Recipients

Abstract: 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.

Cited by 16 publications

References 35 publications

Parenteral Plant Sterols Accumulate in the Liver Reflecting Their Increased Serum Levels and Portal Inflammation in Children With Intestinal Failure

Parenteral Plant Sterols Accumulate in the Liver Reflecting Their Increased Serum Levels and Portal Inflammation in Children With Intestinal Failure

Hemostatic Balance in Pediatric Acute Liver Failure: Epidemiology of Bleeding and Thrombosis, Physiology, and Current Strategies

Posttransplant biopsy risk for stable long-term pediatric liver transplant recipients: 451 percutaneous biopsies from two multicenter immunosuppression withdrawal trials

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