[Liver biopsy in the management of liver dysfunction after allogeneic hematopoietic stem-cell transplantation]

To investigate the pathologic and clinical characteristics of patients with liver dysfunction after allogeneic hemopoietic stem cell transplantation (Allo-HSCT), and evaluate the role of liver biopsy in diagnosis and management of liver dysfunction post Allo-HSCT.

Ten patients with hematological diseases, 5 males and 5 females, aged 34.5 (15-56), underwent Allo-HSCT, 6 receiving Allo-HSCT from their HLA-matched siblings, one receiving haploidentical transplant, two receiving cord blood transplantation from sibling, and one receiving unrelated BMT. The conditioning regimens included Cy/TBI (in 2 cases), and non-TBI regimen (in 8 cases). All the patients received cyclosporine A, short term MTX and MMF for the prophylaxis of graft-versus-host disease (GVHD). Test of liver function and examination of HBV and HCV related serologic markers were performed for the patients and recipients before transplantation and for those who had liver dysfunction after transplantation. Percutaneous liver biopsy was performed for these 10 patients. Biopsy specimens were examined histologically by hematoxylin-eosin staining, Masson staining and immunohistochemical stating of related viruses.

All 10 patients showed liver dysfunction on average 3.5 months (2-5 months) after the transplantation. Seven patients positive in HBV and HCV serologic markers before HSCT remained positive after the transplantation. Three patients negative in HBV/HCV markers before and after Allo-HSCT were diagnosed as with GVHD clinically. Eight patients had other manifestations of chronic GVHD. Eight patients received liver biopsy 5.5 months (4-12 months) because of poor improvement in the initial treatment stage. The result of biopsy showed hepatic GVHD in 3 patients and hepatic GVHD concomitant with HBV or HCV hepatitis reactivation in 7 patients. The liver function of 3 patients diagnosed as with hepatic GVHD returned to normal after the use of the second-line anti-GVHD therapy. The other 7 patients used anti-virus agents combined with immunosuppressive agents with the result that 2 patients remained alive with normal liver function and 5 patients died due to pulmonary complication (2 cases) or hepatic failure and hepatic coma (3 cases).

Liver biopsy is of distinguished diagnostic value for patients with refractory hepatic GVHD after Allo-HSCT. The prognosis is poor for patients having hepatic GVHD concomitant with active hepatic virus infection. At this time the role of liver biopsy is limited and management should be made according to the clinical features and liver pathology.