From the Department of Pediatric Nephrology, Hepatology and Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
the Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Pediatr Gastroenterol Nutr. 2023 May 1;76(5):627-633. doi: 10.1097/MPG.0000000000003707. Epub 2023 Jan 24.
Protocol liver biopsies (PLBs) are part of the follow-up program at many pediatric liver transplant centers, but the impact on clinical decision-making and allograft histology following adjustments of immunosuppression (IS) after PLB has not been thoroughly analyzed.
Following our previous single-center cohort study, we have now evaluated histological findings of 178 PLBs of 118 pediatric patients transplanted at our center between 1998 and 2017. In particular, we focused on the changes in allograft histology in the follow-up biopsy of a subgroup of 22 patients, in which the histologic findings led to an adjustment of immunosuppressive therapy. All biopsies of this sub-study group were reevaluated by an experienced pathologist.
The overall frequency and severity of fibrosis increased over time after orthotopic liver transplantation. Patients with donor-specific antibodies (DSAs) had a higher prevalence of fibrosis than DSA-negative patients. Graft inflammation decreased significantly after intensifying IS, but renal function needs to be monitored. A significant increase in fibrosis was detected in children with reduced IS.
The adjustment of IS following PLBs has a significant impact on allograft histology. Since chronic inflammatory changes may lead to graft failure, adjustment of IS seems to be of major importance for the long-term outcome.
方案肝活检（PLB）是许多儿科肝移植中心随访计划的一部分，但在 PLB 后调整免疫抑制（IS）后对临床决策和移植物组织学的影响尚未得到彻底分析。
在我们之前的单中心队列研究之后，我们现在评估了 1998 年至 2017 年在我们中心接受移植的 118 名儿科患者的 178 份 PLB 的组织学发现。特别是，我们关注了 22 名患者亚组随访活检中移植物组织学的变化，其中组织学发现导致了免疫抑制治疗的调整。该亚组研究的所有活检均由一位经验丰富的病理学家重新评估。
原位肝移植后，纤维化的总体频率和严重程度随时间增加。具有供体特异性抗体（DSA）的患者比 DSA 阴性患者的纤维化患病率更高。强化 IS 后，移植物炎症显著减少，但需要监测肾功能。发现 IS 降低的儿童纤维化显著增加。
PLB 后 IS 的调整对移植物组织学有显著影响。由于慢性炎症变化可能导致移植物失功，因此调整 IS 似乎对长期结果至关重要。
