Background:

Liver biopsies are employed post-transplant generally to evaluate abnormal liver enzymes (LE); however they are not without risk. Whether post-transplant protocol biopsies (PB) serve any purpose in management after transplant remains controversial. This study evaluates the clinical outcomes, histology and safety of PBs when done in those with normal LEs.

Methods

A 1 year analysis of a prospectively maintained medical record was queried in all patients enrolled in a PB pathway. All were post-liver transplant and those with normal LEs prior to biopsy were included. Normal is defined as AST < 40, ALT <45 and Alkaline Phosphatase <100 on more than one reading and normal Doppler ultrasound. All complications, histology and clinic responses to histology identified were collected.

Results

400 PBs were performed in 178 patients of which 84 PBs were associated with normal LE. The most common primary disease was HCV (n=41) followed by NASH (n=16) and in patients with HCV (51% were HCV RNA+ at biopsy). All HCV patient were transplanted while RNA + and treated post-transplant when presenting with advancing fibrosis. On average patients received 1.47 (range 1-6) biopsies and 88% were categorized as abnormal (figure 1). Six of those PBs were found with cirrhosis. Over half of the PBs required intervention including treatment of HCV, evaluation for biliary stricture disease, treatment of rejection or changes to immunosuppression management. 2 PBs had post biopsy fevers with bacteremia and no PBs experienced hemorrhage requiring hospitalization.

Conclusion

Normal liver enzymes are associated with significant pathologies in 88% of PBs and PBs are infrequently associated with complications. In an era of advocating immunosuppression minimization, the increased use of marginal donors, and steatohepatitis recurrence, an increasing role for PB does appear to exist and may become routine and necessary.

CITATION INFORMATION: Sanchez C, Kumer S, Olson S, Gilroy R, Schmitt T, Kane B, Taylor R. Don't Judge a Book by Its Cover: Normal Liver Enzymes After Transplantation Can Be Associated with Pathologies Requiring Intervention. Am J Transplant. 2016;16 (suppl 3).

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