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Histologic abnormalities are common in protocol liver allograft biopsies from patients with normal liver function
Susan C Abraham1, John J Poterucha, Charles B Rosen
1Department of Pathology, M. D. Anderson Cancer Center, Houston, TX, USA.
The American Journal of Surgical Pathology
|May 8, 2008
Summary
Protocol liver allograft biopsies reveal significant histologic abnormalities in 27% of patients, even with normal liver function tests. These findings support routine biopsies for assessing allograft health and detecting subclinical liver disease.
Area of Science:
- Hepatology
- Transplant Surgery
- Pathology
Background:
- The clinical utility of protocol liver allograft biopsies in patients with normal liver function tests (LFTs) is debated.
- Histologic evaluation offers insight into liver diseases present in clinically and biochemically normal allografts.
Purpose of the Study:
- To investigate the prevalence and types of histologic abnormalities in protocol liver allograft biopsies performed during periods of normal clinical and laboratory function.
- To determine the clinical significance of these subclinical findings.
Main Methods:
- Analysis of 165 protocol liver allograft biopsies from 100 transplant patients with normal LFTs and clinical function.
- Biopsies were categorized based on histologic findings, including normal, minimal changes, fatty liver disease, recurrent primary liver disease, and transplant-related disease.
- Assessment of the clinical significance of identified histologic abnormalities.
Main Results:
- Of 165 biopsies, 121 (73%) were normal or showed minimal changes.
- Forty-four biopsies (27%) revealed histologic abnormalities, most commonly fatty liver disease (n=19), central venulitis (n=10), and recurrent primary biliary cirrhosis (n=9).
- Clinically significant histologic changes were identified in 19 cases (11.5%).
Conclusions:
- A substantial proportion of protocol liver allograft biopsies show histologic abnormalities despite normal clinical and laboratory parameters.
- These abnormalities, including fatty liver disease and low-grade recurrent diseases, underscore the value of protocol biopsies for monitoring allograft status.
- Protocol biopsies provide crucial information on subclinical liver diseases in transplanted livers, potentially applicable to native livers as well.
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