The following is a summary of “Protocol Biopsies in Pediatric Liver Transplantation Recipients Improve Graft Histology and Personalize Immunosuppression,” published in the May 2023 issue of Pediatrics by Karbaum, et al.

For a study, researchers sought to analyze the impact of protocol liver biopsies (PLBs) on clinical decision-making and allograft histology following immunosuppression (IS) adjustments in pediatric liver transplant patients.

A cohort of 118 pediatric patients who underwent liver transplantation at a single center between 1998 and 2017 was evaluated. A total of 178 PLBs were performed as part of the follow-up program. Histological findings from the PLBs were analyzed, focusing on a subgroup of 22 patients whose immunosuppressive therapy was adjusted based on the histologic findings. An experienced pathologist reevaluated all biopsies from this subgroup.

Over time after liver transplantation, there was an overall increase in the frequency and severity of fibrosis in the allograft. Patients with donor-specific antibodies (DSAs) had a higher fibrosis prevalence than DSA-negative patients. Intensifying IS led to a significant decrease in graft inflammation, but careful monitoring of renal function was necessary. Children with reduced IS showed a significant increase in fibrosis.

Adjustments of IS based on PLB findings had a significant impact on allograft histology. Since chronic inflammatory changes can contribute to graft failure, the adjustment of IS was crucial for long-term outcomes. Regular monitoring and appropriate modifications of immunosuppressive therapy based on PLB results were important for optimizing patient outcomes in pediatric liver transplant recipients.

Source: journals.lww.com/jpgn/Fulltext/2023/05000/Protocol_Biopsies_in_Pediatric_Liver.13.aspx