Value of Ultrasound‐guided Percutaneous Liver Biopsy in Children Following Liver Transplantation

Sornsakrin, Marijke; Helmke, K.; Briem-Richter, Andrea; Ganschow, Rainer

doi:10.1097/mpg.0b013e3181e7e832

Cited by 18 publications

(29 citation statements)

References 14 publications

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“…Moreover, the liver-transplanted group included fewer patients with other risk factors such as focal lesions and acute liver failure. Our incidence of 1% of major complications in liver-transplanted children is comparable to the 1.7% of Sornsakrin et al (13).…”

Section: Discussionsupporting

confidence: 88%

Evaluation of Risk Factors for Bleeding After Liver Biopsy in Children

Westheim

Østensen²,

Aagenæs³

et al. 2012

J. pediatr. gastroenterol. nutr.

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Ultrasound-guided liver biopsy in children is a procedure with a low rate of major complications and a high rate of minor bleeding not requiring intervention. Treatment with low-dose acetylsalicylic acid did not increase bleeding incidence or total complication rate. Low-molecular-weight heparin and biopsies from focal lesions were risk factors for bleeding complications. Routine ultrasound the day after the procedure did not change handling of the patients.

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Section: Discussionsupporting

confidence: 88%

Evaluation of Risk Factors for Bleeding After Liver Biopsy in Children

Westheim

Østensen²,

Aagenæs³

et al. 2012

J. pediatr. gastroenterol. nutr.

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“…Monitoring and maintaining long‐term graft function in patients with low immunosuppressive medication is a major topic in transplantation medicine. Percutaneously performed liver biopsies are clearly indicated when liver transplant recipients present with elevated liver enzymes and are considered to be a safe procedure . However, the value of protocol liver biopsies as diagnostic tool in children with normal liver function tests remains somewhat controversial.…”

mentioning

confidence: 99%

Liver allograft pathology in healthy pediatric liver transplant recipients

Briem-Richter

Ganschow

Sornsakrin

et al. 2013

Pediatric Transplantation

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Liver transplantation offers excellent results for children with end-stage liver disease, and efforts should be directed toward maintaining long-term graft health. We evaluate graft pathology in healthy pediatric transplant recipients with low-maintenance immunosuppressive medications to assess whether protocol biopsies are helpful for adapting immunosuppression and protecting long-term graft function. Liver biopsies were performed on 60 healthy pediatric liver transplant recipients, and histological findings were correlated with laboratory, serological, and radiological results. Fourteen patients (23%) were diagnosed with acute or early chronic rejection, and immunosuppressive medications were increased in these children. Liver function tests did not correlate with histological findings. The incidence of fibrosis was 36% in transplant recipients five or more years after liver transplantation. We observed an unexpectedly high prevalence of rejection and fibrosis in children with no laboratory abnormalities, which led to changes in their immunosuppressive medications. Scheduled biopsies appear to be useful in pediatric transplant recipients with low immunosuppressive medications for early detection of morphological changes in liver transplants. Further studies are needed to evaluate whether adaption of immunosuppression helps to reduce tissue damage and the incidence of allograft dysfunction in the long term.

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“…Acute cellular rejection (ACR) is a common complication usually occurring within the first 6 weeks after transplantation with an incidence of 30% to 60% . It is suspected when circulating liver enzymes, bilirubin, or both rise, and although biopsy is not performed routinely at all centers, it is required to confirm the diagnosis. However, particularly during the early stages of rejection, biopsy may be inconclusive and thus may need to be repeated before an antirejection treatment can be initiated .…”

mentioning

confidence: 99%

“…However, particularly during the early stages of rejection, biopsy may be inconclusive and thus may need to be repeated before an antirejection treatment can be initiated . Because children need general anesthesia for the procedure and many patients have a relatively high risk for bleeding, some patients are administered high doses of corticosteroids without a histopathological confirmation of the diagnosis …”

mentioning

confidence: 99%

Clinical experience with microdialysis catheters in pediatric liver transplants

et al. 2013

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Ischemic vascular complications and rejection occur more frequently with pediatric liver transplants versus adult liver transplants. Using intrahepatic microdialysis catheters, we measured lactate, pyruvate, glucose, and glycerol values at the bedside for a median of 10 days in 20 pediatric liver grafts. Ischemia (n 5 6), which was defined as a lactate level > 3.0 mM and a lactate/pyruvate ratio > 20, was detected without a measurable time delay with 100% sensitivity and 86% specificity. Rejection (n 5 8), which was defined as a lactate level > 2.0 mM and a lactate/pyruvate ratio < 20 lasting for 6 or more hours, was detected with 88% sensitivity and 45% specificity. With additional clinical criteria, the specificity was 83% without a decrease in the sensitivity. Rejection was detected at a median of 4 days (range 5 1-7 days) before alanine aminotransferase increased (n 5 5, P 5 0.11), at a median of 4 days (range 5 2-9 days) before total bilirubin increased 25% or more (n 5 7, P 5 0.04), and at a median of 6 days (range 5 4-11 days) before biopsy was performed (n 5 8, P 5 0.05). In conclusion, microdialysis catheters can be used to detect episodes of ischemia and rejection before current standard methods in pediatric liver transplants with clinically acceptable levels of sensitivity and specificity. The catheters were well tolerated by the children, and no major complications related to the catheters were observed.

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Value of Ultrasound‐guided Percutaneous Liver Biopsy in Children Following Liver Transplantation

Cited by 18 publications

References 14 publications

Evaluation of Risk Factors for Bleeding After Liver Biopsy in Children

Evaluation of Risk Factors for Bleeding After Liver Biopsy in Children

Liver allograft pathology in healthy pediatric liver transplant recipients

Clinical experience with microdialysis catheters in pediatric liver transplants

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