Role of liver biopsy in the management of liver dysfunction after hematopoietic stem-cell transplantation in a hepatitis B virus-prevalent patient population

Transplantation. 2003 Jul 15;76(1):169-76. doi: 10.1097/01.TP.0000072809.22740.A8.

Abstract

Background: Derangement of liver function tests (LFT) is common after hematopoietic stem-cell transplantation (HSCT). The role of liver biopsy in such cases has not been defined in hepatitis B virus (HBV)-prevalent patients. The impact of liver biopsy in the management of LFT derangement after HSCT in an HBV-prevalent population was examined.

Methods: Seventy-five liver biopsies, performed for 323 patients with LFT derangement post-HSCT (263 allogeneic, 60 autologous), were analyzed. The HBV carrier rate was 13.6%.

Results: Significantly more LFT derangements and therefore liver biopsies occurred in allogeneic versus autologous HSCT. Before biopsy, graft-versus-host disease (GVHD) and HBV reactivation were clinically diagnosed in 70.6% and 25.3% of cases, respectively. A definite histopathologic diagnosis was obtained after biopsy in 53 cases, with GVHD, HBV hepatitis, and concomitant GVHD-HBV hepatitis found in 33%, 21%, and 8% of cases, respectively. The clinical and histopathologic diagnoses were concordant in 43 cases and discordant in 9 cases. Clinical management was altered in six of nine discordant cases, five of which were caused by HBV or hepatitis C virus (HCV) reactivation. Twenty-two biopsy specimens showed nondiagnostic histopathologic features. Twenty of these cases were successfully managed on the basis of clinical diagnoses. The clinical-biochemical features of patients clinically diagnosed to have GVHD did not differ significantly whether or not they were HBV-HCV carriers. However, liver biopsies in HBV-HCV carriers resulted in significantly more treatment alterations as compared with noncarriers.

Conclusions: Clinical diagnoses of LFT derangements post-HSCT might be adequate for initiation of treatment, but liver biopsies in HBV-HCV carriers were needed, as this might impact on management.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Biopsy
  • Female
  • Graft vs Host Disease / epidemiology
  • Hepatitis B / epidemiology*
  • Hepatitis B Surface Antigens / blood
  • Hong Kong / epidemiology
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Leukemia / therapy
  • Liver / pathology*
  • Liver Diseases / etiology*
  • Liver Diseases / pathology
  • Lymphoma / therapy
  • Male
  • Middle Aged
  • Multiple Myeloma / therapy
  • Platelet Count
  • Prevalence
  • Retrospective Studies
  • Stem Cell Transplantation / adverse effects*

Substances

  • Hepatitis B Surface Antigens
  • Immunosuppressive Agents