Clinical value and safety of liver biopsies in patients transplanted for hepatitis C virus-related end-stage liver disease.
BACKGROUND
Hepatitis C is the leading indication for liver transplantation. Differentiation between recurrent graft hepatitis C (RGH-C) and graft rejection (GR) is challenging. Liver biopsy is standard to diagnose both conditions; however, little information is available regarding this procedure in hepatitis C virus (HCV)-infected liver transplant recipients.


METHODS
Liver biopsies (n = 211) from all consecutive patients (n = 138) transplanted for hepatitis C at Hannover Medical School between January 2000 and October 2011 were screened, and a final cohort of 96 patients with 196 biopsies was included. Indications, histopathological findings, and biopsy-related complications were documented. Modifications in the treatment based on the biopsy result and the biochemical outcome were analyzed.


RESULTS
Most biopsies (196/211, 93%) were representative. Five patients (2.5%) developed non-fatal biopsy-related complications. Biopsy results were GR (35%), RGH-C (31%), and other diagnoses (34%). GR was independently associated with lower albumin (P = 0.025) and higher bilirubin levels (P = 0.011). Treatment was modified based on the biopsy result in 25% of cases. Alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), and bilirubin levels improved in 41%, 25%, and 31% of cases 4 weeks post biopsy respectively. ALT improvements were more significant in patients with GR than in those with RGH-C.


CONCLUSIONS
Liver biopsy in HCV-infected liver transplant recipients is safe and representative in >90% of cases. GR is independently associated with lower albumin and higher bilirubin levels.
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
C
C
Brauner
T O
TO
Lankisch
P
P
Fytili
J
J
Jaroszewicz
F
F
Lehner
H
H
Barg-Hock
J
J
Klempnauer
E
E
Jaeckel
M P
MP
Manns
H
H
Wedemeyer
A A
AA
Negm
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000473:pathology; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008099:Liver / Q000473:pathology*; D017093:Liver Failure / Q000209:etiology* / Q000473:pathology* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
hepatitis C virus; liver biopsy; liver transplantation; recurrence; rejection; risk factors