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Importance of liver biopsy findings in immunosuppression management: biopsy monitoring and working criteria for patients with operational tolerance.

Journal article
Authors O Adeyi
Johan Mölne
Published in Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
Volume 18
Issue 10
Pages 1154-70
ISSN 1527-6473
Publication year 2012
Published at Institute of Biomedicine, Department of Pathology
Pages 1154-70
Language en
Links dx.doi.org/10.1002/lt.23481
www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords Adult, Biopsy, Child, Dose-Response Relationship, Drug, Follow-Up Studies, Graft Rejection, prevention & control, Humans, Immunosuppressive Agents, therapeutic use, Liver, pathology, Liver Transplantation, immunology, Transplantation Tolerance, immunology
Subject categories Clinical Laboratory Medicine, Gastroenterology and Hepatology

Abstract

Obstacles to morbidity-free long-term survival after liver transplantation (LT) include complications of immunosuppression (IS), recurrence of the original disease and malignancies, and unexplained chronic hepatitis and graft fibrosis. Many programs attempt to minimize chronic exposure to IS by reducing dosages and stopping steroids. A few programs have successfully weaned a highly select group of recipients from all IS without apparent adverse consequences, but long-term follow-up is limited. Patients subjected to adjustments in IS are usually followed by serial liver chemistry tests, which are relatively insensitive methods for detecting allograft damage. Protocol biopsy has largely been abandoned for hepatitis C virus-negative recipients, at least in part because of the inability to integrate routine histopathological findings into a rational clinical management algorithm. Recognizing a need to more precisely categorize and determine the clinical significance of findings in long-term biopsy samples, the Banff Working Group on Liver Allograft Pathology has reviewed the literature, pooled the experience of its members, and proposed working definitions for biopsy changes that (1) are conducive to lowering IS and are compatible with operational tolerance (OT) and (2) raise concern for closer follow-up and perhaps increased IS during or after IS weaning. The establishment of guidelines should help us to standardize analyses of the effects of various treatments and/or weaning protocols and more rigorously categorize patients who are assumed to show OT. Long-term follow-up using standardized criteria will help us to determine the consequences of lowering IS and to define and determine the incidence and robustness of OT in liver allografts.

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