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Utility and safety of liver biopsy in patients with undetermined liver blood test anomalies after allogeneic hematopoietic stem cell transplantation, a monocentric retrospective cohort study
Ruggiu, M., Bedossa, P., Rautou, P. E., Bertheau, P., Plessier, A., de Latour, R. P., Robin, M., de Fontbrune, F. S., Pagliuca, S., Villate, A., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2018
Abstract
Liver blood test anomalies are common after allogeneic hematopoietic stem cell transplantation (allo-HSCT), but their cause often remains difficult to identify. Our objective was to evaluate the safety and utility of liver biopsies in patients who underwent allo-HSCT. In a retrospective single center cohort study, we reviewed all cases of patients who underwent liver biopsy between June 2005 and July 2017. During this period, 54 biopsies were performed in 45 patients; 38 patients underwent allo-HSCT for malignant and seven for non-malignant hematological disorders. Median time between allo-HSCT and liver biopsy was 213 days. Seven biopsies were percutaneous and 47 transjugular. No adverse event related to the biopsy procedure occurred; 94.5% biopsies (51/54) led to identify a histological diagnose. Cholestatic graft versus host disease was histologically demonstrated in 16 biopsies (30%), hepatitis-like GvHD in nine biopsies (17%), non-alcoholic steatohepatitis in six biopsies (9%), regenerative nodular hyperplasia in four biopsies (5%), and drug-induced liver injury, sinusoidal obstruction syndrome and viral hepatitis each in three biopsies (5%). Association between clinical, laboratory, imaging and pathological features was poor. Only 34% of physicians' pre-biopsy hypotheses were confirmed by pathological findings. Patient management was influenced by liver biopsy results in 65% of cases, allowing us to identify a new diagnosis (n=13), rule out a differential diagnosis (n=14) or confirm the main hypothesis (n=6). In conclusion, liver biopsy is a safe and useful technique to investigate liver blood test anomalies following allo-HSCT.