title: Role of liver biopsy in the management of liver dysfunction after hematopoietic stem-cell transplantation in a hepatitis B virus-prevalent patient population.
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.
authors.affiliation: University Department of Medicine, Queen Mary Hospital, Hong Kong.
authors.forename: Shing-Yan
authors.initials: SY
authors.lastname: Ma
authors.forename: Wing-Yan
authors.initials: WY
authors.lastname: Au
authors.forename: Irene O L
authors.initials: IO
authors.lastname: Ng
authors.forename: Albert K W
authors.initials: AK
authors.lastname: Lie
authors.forename: Anskar Y H
authors.initials: AY
authors.lastname: Leung
authors.forename: Raymond H S
authors.initials: RH
authors.lastname: Liang
authors.forename: George K K
authors.initials: GK
authors.lastname: Lau
authors.forename: Yok-Lam
authors.initials: YL
authors.lastname: Kwong
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology; D006509:Hepatitis B / Q000453:epidemiology*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007938:Leukemia / Q000628:therapy; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000209:etiology* / Q000473:pathology; D008223:Lymphoma / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy; D010976:Platelet Count; D015995:Prevalence; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects*
chemical_list: D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents