Laboratoire d'Anatomie pathologique, AP-HP Hôpital Paul Brousse, Villejuif, France.
J Hepatol. 2012 Apr;56(4):840-7. doi: 10.1016/j.jhep.2011.11.016. Epub 2011 Dec 13.
BACKGROUND & AIMS: Most liver transplant centres have discontinued the practice of protocol liver biopsies (LB), mainly because of the perceived lack of therapeutic benefit. This study aimed to examine the usefulness of 20-year LBs.
Ten, 15, and 20-year protocol LBs from 147 patients surviving for >20 years were reviewed. Twenty-year biopsy findings were correlated with clinical data.
Twenty-year-biopsy patients (N=91) and 20-year-non-biopsy patients (N=56) were similar in terms of transplant data, adverse events, and liver function tests (LFTs). Twenty-year LBs revealed a 90% prevalence of abnormalities, among which viral chronic hepatitis (VCH) was the most common (46%). Between 15 and 20 years, hepatic structural abnormalities were the only disorder to increase (p=0.008). An individual progression of abnormalities occurred in 56% of patients. At 20 years, the negative and positive predictive values (PV) of LFTs with respect to histological abnormalities were 95% and 18%, respectively; in VCH, Fibrotest and transient elastography displayed poor discriminative ability for fibrosis (80% and 81% discordance, respectively), but were satisfactory regarding significant fibrosis (negative PV of 77.7% and 80%, respectively). A decrease in immunosuppression was less frequent (14/91 vs. 20/56, p=0.008) while an increase was more common (15/91 vs. 2/56, p=0.017) in 20-year-biopsy patients than in non-biopsy patients. Antiviral therapy was administered in seven of the 20-year biopsy patients, but in none of the non-biopsy patients (p=0.04).
Twenty-year LBs provided important histological information on graft function that was available to a limited degree from LFTs and non-invasive markers. They exerted an impact on immunosuppressive and antiviral therapies.
大多数肝移植中心已停止进行方案性肝活检（LB），主要是因为认为其缺乏治疗益处。本研究旨在研究 20 年 LB 的有用性。
对 147 例存活时间超过 20 年的患者的 10 年、15 年和 20 年的方案性 LB 进行了回顾性研究。将 20 年的活检结果与临床数据相关联。
20 年 LB 患者（N=91）和 20 年非 LB 患者（N=56）在移植数据、不良事件和肝功能检查（LFTs）方面相似。20 年 LB 显示异常的发生率为 90%，其中病毒性慢性肝炎（VCH）最常见（46%）。在 15 至 20 年间，肝结构异常是唯一增加的疾病（p=0.008）。56%的患者出现了异常的个体进展。20 年时，LFT 对组织学异常的阴性和阳性预测值（PV）分别为 95%和 18%；在 VCH 中，Fibrotest 和瞬时弹性成像对纤维化的鉴别能力较差（分别为 80%和 81%的不相符），但对显著纤维化具有令人满意的表现（阴性 PV 分别为 77.7%和 80%）。与非 LB 患者相比，20 年 LB 患者减少免疫抑制治疗的频率较低（14/91 与 20/56，p=0.008），增加免疫抑制治疗的频率较高（15/91 与 2/56，p=0.017）。在 20 年 LB 患者中有 7 例接受了抗病毒治疗，但在非 LB 患者中没有（p=0.04）。
20 年 LB 提供了有关移植物功能的重要组织学信息，而这些信息在一定程度上可以通过 LFT 和非侵入性标志物获得。它们对免疫抑制和抗病毒治疗有影响。
