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Protocol liver biopsy predicts graft survival after liver transplantation
Ville H Liukkonen1,2, Arno J Nordin3, Martti A Färkkilä2
1Gastroenterology, North Karelia Central Hospital, Joensuu, Finland.
Clinical Transplantation
|March 20, 2024
Summary
Protocol liver biopsies are valuable for monitoring liver transplant recipients, frequently identifying significant changes impacting graft survival, even with normal liver function tests. These findings support their routine use in post-transplant care.
Area of Science:
- Hepatology
- Transplantation Medicine
- Pathology
Background:
- The clinical utility of protocol liver biopsies in monitoring liver allograft status is debated.
- Limited data exists from contemporary liver transplantation cohorts regarding the predictive value of protocol biopsies for clinical outcomes.
Purpose of the Study:
- To evaluate the predictive value of protocol liver biopsies for long-term outcomes in liver transplant recipients.
- To assess the ability of histologic components in protocol biopsies to predict graft survival.
- To determine the frequency of significant biopsy findings and their correlation with liver function tests (LFTs) and clinical markers.
Main Methods:
- Analysis of 867 protocol liver biopsies from 875 liver transplant patients (2000-2019) at Helsinki University Hospital.
- Histologic components were assessed for prediction of graft survival and long-term outcomes.
- Significant biopsy findings were defined using Banff working group criteria; LFTs and clinical markers were evaluated for predictive capability.
Main Results:
- Significant findings were present in 20.1% of protocol biopsies.
- Steatohepatitis and moderate/severe congestion in the first biopsy predicted graft loss (HR 3.504, p=.03; HR 3.338, p=.04).
- Cholangitis, necrosis, mild congestion, and any significant finding predicted inferior death-censored graft survival (HRs ranging from 2.563 to 7.635). LFTs showed poor discrimination for significant biopsy findings (AUC .572-.696).
Conclusions:
- Protocol liver biopsies frequently reveal significant histologic changes associated with long-term outcomes after liver transplantation.
- These findings support the routine use of protocol liver biopsies for monitoring liver allograft status, even when LFTs are within normal limits.
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