Role of liver biopsy in the management of liver dysfunction after hematopoietic stem-cell transplantation in a hepatitis B virus-prevalent patient population.
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.
Ma
Shing-Yan
SY
University Department of Medicine, Queen Mary Hospital, Hong Kong.
Au
Wing-Yan
WY
Ng
Irene O L
IO
Lie
Albert K W
AK
Leung
Anskar Y H
AY
Liang
Raymond H S
RH
Lau
George K K
GK
Kwong
Yok-Lam
YL
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*
D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents