title: Safety and utility of liver biopsy after pediatric hematopoietic stem cell transplantation.
abstract: Liver dysfunction is common after pediatric hematopoietic stem cell transplantation (HSCT) and liver biopsy may be necessary to diagnosis the cause of liver dysfunction and institute therapy. We report our liver biopsy experience in 356 consecutive patients. During the study period, 16 (4.5%) patients underwent 18 biopsies, all after allogeneic HSCT. The median time from HSCT to biopsy was 205.5 days. All patients had transaminase elevation and 67% had hyperbilirubinemia. The most commonly used method of biopsy was the imaging-guided percutaneous approach, performed in 12 of 18 cases. Five biopsies were done transjugularly and 1 was performed during laparotomy. In all the cases a histopathologic diagnosis was made. The most common diagnosis was graft-versus-host disease (GVHD) followed by iron overload. In 12 cases, management was modified based on biopsy results. Complications occurred after 5 biopsies, 4 of which were performed transjugularly. The most common complication was hemorrhage. Two patients required transfer to the intensive care unit for related complications. No complications were observed after percutaneous biopsies. In 2 cases a second procedure was required to manage the complication. We conclude that while liver biopsy yields a high-rate of diagnoses, it is accompanied by high rates of complications, particularly when the transjugular approach is used.
authors.affiliation: Children's Hospital Boston †Dana-Farber Cancer Institute, Boston, MA, USA. benjamin.oshrine@childrens.harvard.edu
authors.forename: Benjamin
authors.initials: B
authors.lastname: Oshrine
authors.forename: Leslie E
authors.initials: LE
authors.lastname: Lehmann
authors.forename: Christine N
authors.initials: CN
authors.lastname: Duncan
mesh_terms: D000293:Adolescent; D001663:Bilirubin / Q000097:blood; D001706:Biopsy / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000209:etiology; D008297:Male
chemical_list: D001663:Bilirubin