Long-term Outcome of Asymptomatic Patients With Graft Fibrosis in Protocol Biopsies After Pediatric Liver Transplantation
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved..
BACKGROUND: The histological prevalence of allograft fibrosis in asymptomatic children after liver transplantation (LT) is well documented. However, long-term graft and patient survival remain unclear. This retrospective multicenter study aims to determine the prevalence of allograft fibrosis and analyze the long-term outcome for patients transplanted in childhood.
METHODS: We reviewed clinical data of children who had undergone 10-y protocol liver biopsies. We excluded patients with autoimmune hepatitis, primary sclerosing cholangitis, hepatitis B or C, and retransplantation. In total, 494 patients transplanted in childhood across 12 international transplant centers were included. We evaluated the development of fibrosis by comparing the results with biopsies obtained 5 and 15 y post-LT. Histological findings were correlated with graft and patient survival up to 20 y post-LT.
RESULTS: In the 10-y biopsies, periportal or pericentral fibrosis was observed in 253 patients (51%), 87 (18%) had bridging fibrosis, 30 (6%) had cirrhosis, and 124 (25%) had no fibrosis. The prevalence and stage of graft fibrosis significantly progressed from 5 to 10 y. At 10 y, the severity of fibrosis correlated significantly with inflammation. Patients with graft cirrhosis in the 10-y biopsy were more likely to die or require retransplantation subsequently ( P = 0.027).
CONCLUSIONS: At 10 y post-LT, most patients transplanted in childhood developed fibrosis, based on the protocol liver biopsies. Although mild-to-moderate graft fibrosis did not largely affect patient or graft survival up to 20 y post-LT, this progressive fibrosis finding has substantial implications for developing cirrhosis and portal hypertension in adult care.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:107 |
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| Enthalten in: |
Transplantation - 107(2023), 11 vom: 01. Nov., Seite 2394-2405 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hartleif, Steffen [VerfasserIn] |
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| Anmerkungen: |
Date Revised 23.10.2023 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1097/TP.0000000000004603 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM356464520 |
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| 245 | 1 | 0 | |a Long-term Outcome of Asymptomatic Patients With Graft Fibrosis in Protocol Biopsies After Pediatric Liver Transplantation |
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| 500 | |a Date Revised 23.10.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: The histological prevalence of allograft fibrosis in asymptomatic children after liver transplantation (LT) is well documented. However, long-term graft and patient survival remain unclear. This retrospective multicenter study aims to determine the prevalence of allograft fibrosis and analyze the long-term outcome for patients transplanted in childhood | ||
| 520 | |a METHODS: We reviewed clinical data of children who had undergone 10-y protocol liver biopsies. We excluded patients with autoimmune hepatitis, primary sclerosing cholangitis, hepatitis B or C, and retransplantation. In total, 494 patients transplanted in childhood across 12 international transplant centers were included. We evaluated the development of fibrosis by comparing the results with biopsies obtained 5 and 15 y post-LT. Histological findings were correlated with graft and patient survival up to 20 y post-LT | ||
| 520 | |a RESULTS: In the 10-y biopsies, periportal or pericentral fibrosis was observed in 253 patients (51%), 87 (18%) had bridging fibrosis, 30 (6%) had cirrhosis, and 124 (25%) had no fibrosis. The prevalence and stage of graft fibrosis significantly progressed from 5 to 10 y. At 10 y, the severity of fibrosis correlated significantly with inflammation. Patients with graft cirrhosis in the 10-y biopsy were more likely to die or require retransplantation subsequently ( P = 0.027) | ||
| 520 | |a CONCLUSIONS: At 10 y post-LT, most patients transplanted in childhood developed fibrosis, based on the protocol liver biopsies. Although mild-to-moderate graft fibrosis did not largely affect patient or graft survival up to 20 y post-LT, this progressive fibrosis finding has substantial implications for developing cirrhosis and portal hypertension in adult care | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Hodson, James |e verfasserin |4 aut | |
| 700 | 1 | |a Lloyd, Carla |e verfasserin |4 aut | |
| 700 | 1 | |a Cousin, Vladimir L |e verfasserin |4 aut | |
| 700 | 1 | |a Czubkowski, Piotr |e verfasserin |4 aut | |
| 700 | 1 | |a D'Antiga, Lorenzo |e verfasserin |4 aut | |
| 700 | 1 | |a Debray, Dominique |e verfasserin |4 aut | |
| 700 | 1 | |a Demetris, Anthony |e verfasserin |4 aut | |
| 700 | 1 | |a Di Giorgio, Angelo |e verfasserin |4 aut | |
| 700 | 1 | |a Evans, Helen M |e verfasserin |4 aut | |
| 700 | 1 | |a Fischler, Björn |e verfasserin |4 aut | |
| 700 | 1 | |a Gonzales, Emmanuel |e verfasserin |4 aut | |
| 700 | 1 | |a Gouw, Annette S H |e verfasserin |4 aut | |
| 700 | 1 | |a Hübscher, Stefan G |e verfasserin |4 aut | |
| 700 | 1 | |a Jacquemin, Emmanuel |e verfasserin |4 aut | |
| 700 | 1 | |a Lacaille, Florence |e verfasserin |4 aut | |
| 700 | 1 | |a Malenicka, Silvia |e verfasserin |4 aut | |
| 700 | 1 | |a McLin, Valerie A |e verfasserin |4 aut | |
| 700 | 1 | |a Markiewicz-Kijewska, Małgorzata |e verfasserin |4 aut | |
| 700 | 1 | |a Mazariegos, George V |e verfasserin |4 aut | |
| 700 | 1 | |a Rajanayagam, Jeremy K |e verfasserin |4 aut | |
| 700 | 1 | |a Scheenstra, René |e verfasserin |4 aut | |
| 700 | 1 | |a Singer, Stephan |e verfasserin |4 aut | |
| 700 | 1 | |a Smets, Françoise |e verfasserin |4 aut | |
| 700 | 1 | |a Sokal, Etienne |e verfasserin |4 aut | |
| 700 | 1 | |a Squires, James E |e verfasserin |4 aut | |
| 700 | 1 | |a Sturm, Ekkehard |e verfasserin |4 aut | |
| 700 | 1 | |a Verkade, Henkjan |e verfasserin |4 aut | |
| 700 | 1 | |a Kelly, Deirdre A |e verfasserin |4 aut | |
| 700 | 0 | |a Graft Injury Group (GIG) |e verfasserin |4 aut | |
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