title: "Safety and utility of percutaneous liver biopsy in hematopoietic stem cell transplant pediatric recipients: a retrospective study".
abstract: Liver biopsies in pediatric hematopoietic stem cell transplantation (HSCT) patients are as and effective when performed at bedside in the Bone Marrow Transplant Unit (BMTU) than in the Day Surgery Unit (DSU), with better patient compliance and lower emotional distress for these children.
  
  
  
  The study group consisted of 45 children who underwent allogeneic HSCT. We reviewed 68 liver biopsies performed between April 2006 and September 2015. 12 (17.6 %) biopsies were performed in the DSU and 56 (82.3 %) in the BMTU; nine (13.2 %) prior to HSCT and 59 (86.7 %) after HSCT. Pre-procedural behavioral status (subjective score) was evaluated by pediatric transplant physicians by filling in a questionnaire employing a three-point scale: "calm and cooperative", "agitated and non-cooperative" or "frightened and suffering". Objective score was obtained measuring patient's heart rate before the procedure and comparing it with mean heart rate.
  
  
  
  Patients who underwent the procedure at the BMTU experienced less emotional distress than those who underwent it in the DSU: 58.3 % of patients treated at the DSU were agitated as compared with 16.1 % of those treated at the BMTU (p < 0.01). Among the 59 biopsies performed after HSCT, 41 (69.5 %) were taken from symptomatic patients for a diagnostic purpose and 18 (30.5 %) in asymptomatic ones in order to rule out hepatic GVHD. Among these 18 procedures, GVHD was diagnosed in 16 (88.9 %) cases. Minor complications occurred in about 17 % of procedures (12 biopsies), at a rate of 25 % for the DSU location compared with 16 % for the BMTU location. Only two major complications were reported, one in the DSU and one in the BMTU.
  
  
  
  Liver biopsy performed at bedside in HSCT patients does not carry a higher risk of adverse events than the same procedure performed in the DSU and has lower emotional distress associated with better patient compliance, thus contributing significantly to a higher standard of care.
authors.affiliation: Bone Marrow Transplant Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, via dell'Istria 65/1, 34137, Trieste, Italy. natalia.maximova@burlo.trieste.it.
authors.forename: Natalia
authors.initials: N
authors.lastname: Maximova
authors.affiliation: Department of Radiology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Gregori
authors.affiliation: Department of Pediatrics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, University of Trieste, Trieste, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Barbieri
authors.affiliation: Department of Pediatrics, University of Turin, Turin, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pizzol
authors.affiliation: Department of Pathology, Ospedale Beato Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Sonzogni
mesh_terms: D000293:Adolescent; D001706:Biopsy / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008099:Liver / Q000473:pathology*; D008297:Male; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014184:Transplantation, Homologous
keywords: Allogeneic hematopoietic stem cell transplantation; Child emotional distress; Liver graft versus host disease; Pediatric patients; Percutaneous liver biopsy