Mandal Soma, Miraglia Roberto, Maruzzelli Luigi, Liotta Rosa, Tuzzolino Fabio, Spada Marco, Riva Silvia, Luca Angelo
*Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA †Diagnostic and Therapeutic Services ‡Department of Information Technology §Transplantation Surgery ||Pediatric Hepatology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Palermo, Italy.
J Pediatr Gastroenterol Nutr. 2014 Jun;58(6):756-61. doi: 10.1097/MPG.0000000000000328.
The present study assesses the safety of ultrasound (US)-guided percutaneous liver biopsies (PLBs) within pediatric liver allograft recipients, describes the pathological results according to early (≤12 months) and late (>12 months) posttransplantation periods, and analyzes the value of liver function tests (LFTs) and Doppler US variables in determining these results.
A total of 219 US-guided PLBs in 85 pediatric patients with liver transplant (mean age 7 ± 5 years, range: 6 months to 18 years) performed between March 2005 and May 2012 were retrospectively evaluated at a single institution. Doppler US and LFT evaluation (including total bilirubin, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, alkaline phosphatase) occurred within 1 day of early (n = 92, 42%) and late term (n = 127, 58%) posttransplantation biopsies.
The rate of major complications (hemorrhage requiring blood transfusion) was 0.91% (n = 2). The early versus late term biopsy results, respectively, included: cholestasis at 36% versus 18% (P = 0.003), minimal changes 16% versus 24% (not significant [NS]), acute rejection 13% versus 5% (P = 0.027), inflammatory diseases 15% versus 15% (NS), indeterminate acute rejection 11% versus 7% (NS), chronic rejection 4% versus 14% (P = 0.017), fibrotic diseases 4% versus 12% (NS), and other 0% versus 5% (NS). Neither LFT nor US variables were correlated with pathological outcomes.
The rate of complications in pediatric patients after US-guided liver biopsy is low. A range of pathological results exists between early and late posttransplantation liver biopsies. LFT and Doppler US findings are not predictors of pathological results.
本研究评估超声（US）引导下经皮肝穿刺活检（PLB）在小儿肝移植受者中的安全性，描述根据移植后早期（≤12个月）和晚期（>12个月）的病理结果，并分析肝功能检查（LFT）和多普勒超声变量在确定这些结果中的价值。
回顾性评估了2005年3月至2012年5月期间在单一机构对85例小儿肝移植患者（平均年龄7±5岁，范围：6个月至18岁）进行的总共219次US引导下的PLB。在移植后早期（n = 92，42%）和晚期（n = 127，58%）活检的1天内进行了多普勒超声和LFT评估（包括总胆红素、丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转移酶、碱性磷酸酶）。
主要并发症（需要输血的出血）发生率为0.91%（n = 2）。早期与晚期活检结果分别包括：胆汁淤积为36%对18%（P = 0.003），微小变化为16%对24%（无显著性差异[NS]），急性排斥反应为13%对5%（P = 0.027），炎症性疾病为15%对15%（NS），不确定的急性排斥反应为11%对7%（NS），慢性排斥反应为4%对14%（P = 0.017），纤维化疾病为4%对12%（NS），其他为0%对5%（NS）。LFT和超声变量均与病理结果无关。
小儿患者在US引导下肝活检后的并发症发生率较低。移植后早期和晚期肝活检存在一系列病理结果。LFT和多普勒超声检查结果不是病理结果的预测指标。
