The value of late protocol biopsies after liver transplantation remains to be evaluated.
In this study, researchers from France assessed 143 patients who had survived with their initial graft, and had a 10-year protocol biopsy.
They evaluated long-term histologic outcome of the graft, particularly the rate of ductopenia in cases with chronic rejection (CR). They also assessed Metavir scoring of fibrosis in cases with viral chronic hepatitis (VCH).
In addition, the researchers compared fibrosis progression (FP) rates were compared over 3 periods (0 to 5, 5 to 10, and 0 to10 years).
|Histologic abnormalities present in 80% of the patients were not identifiable from liver function tests.|
The research team found that, at 10 years, the histologic abnormalities present in 80% of the patients were not identifiable from liver function tests (LFTs). These were strictly normal in 52% of the patients.
Furthermore, histologic CR occurred in 24% of patients 10 years after transplantation. The mean rate of ductopenia was higher at 10 years (49%) than at 5 years (34%).
The team also found that, in cases of VCH, fibrosis worsened at a median FP rate of 0.20 fibrosis units per year.
They determined that in the first 5 years, FP in patients with hepatitis B virus infection was greater than recurrent hepatitis C virus (HCV) infection. This was greater than FP in acquired HCV infection.
The team found that in patients with HCV, FP was higher during the second 5-year period than during the first one.
Dr Mylène Sebagh's team concluded, "Given the high prevalence of histologic abnormalities and the lack of sensitivity and specificity of LFTs, late protocol biopsies clearly are justified to adjust treatments".
"Not only in HCV-infected patients in whom FP was fast and not linear, but also in the whole population of recipients"