title: Twenty-year protocol liver biopsies: Invasive but useful for the management of liver recipients.
abstract: OBJECTIVE
  Most liver transplant centres have discontinued the practice of protocol liver biopsies (LB), mainly because of the perceived lack of therapeutic benefit. This study aimed to examine the usefulness of 20-year LBs.
  
  
  METHODS
  Ten, 15, and 20-year protocol LBs from 147 patients surviving for >20 years were reviewed. Twenty-year biopsy findings were correlated with clinical data.
  
  
  RESULTS
  Twenty-year-biopsy patients (N=91) and 20-year-non-biopsy patients (N=56) were similar in terms of transplant data, adverse events, and liver function tests (LFTs). Twenty-year LBs revealed a 90% prevalence of abnormalities, among which viral chronic hepatitis (VCH) was the most common (46%). Between 15 and 20 years, hepatic structural abnormalities were the only disorder to increase (p=0.008). An individual progression of abnormalities occurred in 56% of patients. At 20 years, the negative and positive predictive values (PV) of LFTs with respect to histological abnormalities were 95% and 18%, respectively; in VCH, Fibrotest and transient elastography displayed poor discriminative ability for fibrosis (80% and 81% discordance, respectively), but were satisfactory regarding significant fibrosis (negative PV of 77.7% and 80%, respectively). A decrease in immunosuppression was less frequent (14/91 vs. 20/56, p=0.008) while an increase was more common (15/91 vs. 2/56, p=0.017) in 20-year-biopsy patients than in non-biopsy patients. Antiviral therapy was administered in seven of the 20-year biopsy patients, but in none of the non-biopsy patients (p=0.04).
  
  
  CONCLUSIONS
  Twenty-year LBs provided important histological information on graft function that was available to a limited degree from LFTs and non-invasive markers. They exerted an impact on immunosuppressive and antiviral therapies.
authors.affiliation: Laboratoire d'Anatomie pathologique, AP-HP Hôpital Paul Brousse, Villejuif, France. mylene.sebagh@pbr.aphp.fr
authors.forename: Mylène
authors.initials: M
authors.lastname: Sebagh
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
authors.forename: Teresa Maria
authors.initials: TM
authors.lastname: Antonini
authors.forename: Audrey
authors.initials: A
authors.lastname: Coilly
authors.forename: Davide
authors.initials: D
authors.lastname: Degli Esposti
authors.forename: Bruno
authors.initials: B
authors.lastname: Roche
authors.forename: Vincent
authors.initials: V
authors.lastname: Karam
authors.forename: Alexandre
authors.initials: A
authors.lastname: Dos Santos
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Duclos-Vallée
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Roque-Afonso
authors.forename: Eric
authors.initials: E
authors.lastname: Ballot
authors.forename: Catherine
authors.initials: C
authors.lastname: Guettier
authors.forename: Frédérique
authors.initials: F
authors.lastname: Blandin
authors.forename: Faouzi
authors.initials: F
authors.lastname: Saliba
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D006085:Graft Survival; D006521:Hepatitis, Chronic / Q000453:epidemiology; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000502:physiology; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000473:pathology* / Q000502:physiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome