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Liver Histopathology in Late Protocol Biopsies after Pediatric Liver Transplantation
Małgorzata Markiewicz-Kijewska1, Sylwia Szymańska2, Michal Pyzlak3
1The Department of Pediatric Surgery and Organs Transplantation, The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
Insights
Pediatric liver transplant recipients often show graft abnormalities on biopsy years later, even with normal lab tests. Protocol biopsies are crucial for detecting these subclinical changes and ensuring long-term graft health.
Area of Science:
- Pediatric Hepatology
- Transplant Pathology
- Immunology
Background:
- Liver transplantation is a standard treatment for pediatric end-stage liver failure.
- Long-term survival has improved, leading to extended graft exposure to injury.
- Standard biochemical tests may not detect subtle graft damage.
Purpose of the Study:
- To analyze the histopathology of liver grafts in pediatric patients undergoing late protocol biopsies.
- To correlate graft histopathology with clinical and biochemical status.
- To assess the prevalence of fibrosis, inflammation, steatosis, and rejection.
Main Methods:
- Analysis of 61 protocol liver biopsies from pediatric patients.
- Biopsies were taken 9-17 years post-transplantation.
- Histopathological examination focused on fibrosis, inflammation, steatosis, and rejection using Ishak scoring.
Main Results:
- No abnormalities were found in 42.6% of biopsies.
- No signs of acute or chronic rejection were detected.
- Fibrosis (Ishak ≥3) was present in 28% of patients, with severe fibrosis (Ishak 5-6) in 11.5%. Non-specific lymphoid infiltrates were found in 37.7%.
Conclusions:
- Pathomorphological abnormalities are common in pediatric liver grafts years after transplantation.
- These abnormalities can occur despite normal or near-normal liver function tests, indicating subclinical processes.
- Protocol liver biopsies are essential for monitoring graft health in these patients.
Abstract:
Liver transplantation has become a routine treatment for children with end stage liver failure. Recently, the long term survival of pediatric patients after liver transplantation has improved, with a life expectancy much longer than that of adult recipients, but also with longer exposition of the graft to various injuries, including immunological, inflammatory and others. Biochemical tests, although important, do not always reflect graft injury. The aim of our study was to analyze the histopathology of the graft in late protocol biopsies and correlate it with the clinical and biochemical status of these patients. We analyzed 61 protocol liver biopsies taken from 61 patients. Biopsies were taken 9.03-17.09 years (mean 12.68, median 11.74 years) after transplantation. Liver specimens were examined particularly for the presence and stage of liver fibrosis, inflammation, steatosis, and acute or chronic cellular and humoral rejection. We did not find any abnormalities in 26 (42.6%) liver specimens. None of the patients had signs of cellular or antibody mediated rejection or chronic rejection. In 23 liver biopsies (37.7%), we found non-specific lymphoid infiltrates. Another problem was fibrosis (equal to or more than three on the Ishak scale)-we found it in 17 patients, including seven liver specimens (11.5%) with severe fibrosis (Ishak 5-6). Conclusions: Various pathomorphological abnormalities were found in more than half of patients with a median 11.74 years post-transplant follow-up. Most of them presented normal laboratory liver tests at the same time, suggesting a slow subclinical process leading to pathomorphological abnormalities. No single factor for the development of these abnormalities was found, but our study supports the need for protocol liver biopsies even in patients with normal/almost normal biochemical liver tests.
