title: Utility of liver biopsy in predicting clinical outcomes after percutaneous angioplasty for hepatic venous obstruction in liver transplant patients.
abstract: OBJECTIVE
  To determine utility of transplant liver biopsy in evaluating efficacy of percutaneous transluminal angioplasty (PTA) for hepatic venous obstruction (HVOO).
  
  
  METHODS
  Adult liver transplant patients treated with PTA for HVOO (2003-2013) at a single institution were reviewed for pre/post-PTA imaging findings, manometry (gradient with right atrium), presence of HVOO on pre-PTA and post-PTA early and late biopsy (EB and LB, < or > 60 d after PTA), and clinical outcome, defined as good (no clinical issues, non-HVOO-related death) or poor (surgical correction, recurrent HVOO, or HVOO-related death).
  
  
  RESULTS
  Fifteen patients meeting inclusion criteria underwent 21 PTA, 658 ± 1293 d after transplant. In procedures with pre-PTA biopsy (n = 19), no difference was seen between pre-PTA gradient in 13/19 procedures with HVOO on biopsy and 6/19 procedures without HVOO (8 ± 2.4 mmHg vs 6.8 ± 4.3 mmHg; P = 0.35). Post-PTA, 10/21 livers had EB (29 ± 21 d) and 9/21 livers had LB (153 ± 81 d). On clinical follow-up (392 ± 773 d), HVOO on LB resulted in poor outcomes and absence of HVOO on LB resulted good outcomes. Patients with HVOO on EB (3/7 good, 4/7 poor) and no HVOO on EB (2/3 good, 1/3 poor) had mixed outcomes.
  
  
  CONCLUSIONS
  Negative liver biopsy greater than 60 d after PTA accurately identifies patients with good clinical outcomes.
authors.affiliation: Ammar Sarwar, Edward Ahn, Ian Brennan, Olga R Brook, Salomao Faintuch, Muneeb Ahmed, Divison of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States.
authors.forename: Ammar
authors.initials: A
authors.lastname: Sarwar
authors.affiliation: Ammar Sarwar, Edward Ahn, Ian Brennan, Olga R Brook, Salomao Faintuch, Muneeb Ahmed, Divison of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States.
authors.forename: Edward
authors.initials: E
authors.lastname: Ahn
authors.affiliation: Ammar Sarwar, Edward Ahn, Ian Brennan, Olga R Brook, Salomao Faintuch, Muneeb Ahmed, Divison of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States.
authors.forename: Ian
authors.initials: I
authors.lastname: Brennan
authors.affiliation: Ammar Sarwar, Edward Ahn, Ian Brennan, Olga R Brook, Salomao Faintuch, Muneeb Ahmed, Divison of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States.
authors.forename: Olga R
authors.initials: OR
authors.lastname: Brook
authors.affiliation: Ammar Sarwar, Edward Ahn, Ian Brennan, Olga R Brook, Salomao Faintuch, Muneeb Ahmed, Divison of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States.
authors.forename: Salomao
authors.initials: S
authors.lastname: Faintuch
authors.affiliation: Ammar Sarwar, Edward Ahn, Ian Brennan, Olga R Brook, Salomao Faintuch, Muneeb Ahmed, Divison of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States.
authors.forename: Raza
authors.initials: R
authors.lastname: Malik
authors.affiliation: Ammar Sarwar, Edward Ahn, Ian Brennan, Olga R Brook, Salomao Faintuch, Muneeb Ahmed, Divison of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States.
authors.forename: Khalid
authors.initials: K
authors.lastname: Khwaja
authors.affiliation: Ammar Sarwar, Edward Ahn, Ian Brennan, Olga R Brook, Salomao Faintuch, Muneeb Ahmed, Divison of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States.
authors.forename: Muneeb
authors.initials: M
authors.lastname: Ahmed
keywords: Angioplasty; Hepatic venous outflow obstruction; Liver transplantation; Post-transplant biopsy