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Low‐dose steroids associated with milder histological changes after pediatric liver transplantation
Author(s) -
Kosola Silja,
Lampela Hanna,
Jalanko Hannu,
Mäkisalo Heikki,
Lohi Jouko,
Arola Johanna,
Pakarinen Mikko P.
Publication year - 2013
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.23565
Subject(s) - medicine , gastroenterology , steatosis , biopsy , liver biopsy , immunosuppression , fibrosis , liver transplantation , stage (stratigraphy) , histology , cholestasis , transplantation , pathology , paleontology , biology
Controversy remains about the role of protocol liver biopsy for symptom‐free recipients and about the long‐term use of low‐dose steroids after pediatric liver transplantation (LT). We conducted a national cross‐sectional study of pediatric recipients who underwent LT between 1987 and 2007. Liver biopsy samples were taken from 54 patients (82% of survivors) after a median posttransplant follow‐up of 11 years, and they were reviewed by 2 pathologists blinded to the clinical data. Biopsy samples from 18 patients (33%) showed nearly normal histology with no inflammation, fibrosis, or steatosis. Portal inflammation was detected in 14 samples (26%), showed no correlation with anti‐nuclear antibodies, and was less frequent in the 35 patients whose immunosuppression included steroids (14% versus 47% of patients not using steroids, P = 0.009). Fibrosis was present in 21 biopsy samples (39%). According to the Metavir classification, 15 were stage 1, 4 were stage 2, and 2 were stage 3. The fibrosis stage correlated negatively with serum prealbumin levels ( r = −0.364, P = 0.007) and positively with chronic cholestasis (cytokeratin 7 staining; r = 0.546, P < 0.001) and portal inflammation ( r = 0.350, P = 0.01). Microvesicular steatosis was found in 23 biopsy samples (43% of patients in 5%‐80% of hepatocytes), and it correlated with the body mass index ( r = 0.517, P < 0.001) but not with steroid use. The age of the allograft (donor age plus follow‐up time) correlated with higher serum gamma‐glutamyltransferase ( r = 0.472, P < 0.001) and conjugated bilirubin levels ( r = 0.420, P = 0.002) as well as chronic cholestasis ( r = 0.305, P = 0.03). The biopsy findings led to treatment changes in 10 patients (19%), whereas only 1 complication (subcapsular hematoma) was encountered. In conclusion, continuing low‐dose steroids indefinitely after pediatric LT may have a positive effect on the long‐term histological state of the liver graft. Allograft aging may lead to chronic cholestasis and thus contribute to the development of liver fibrosis. Liver Transpl 19:145–154, 2013. © 2012 AASLD.