Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 18, 2015; 7(14): 1884-1893
Published online Jul 18, 2015. doi: 10.4254/wjh.v7.i14.1884
Utility of liver biopsy in predicting clinical outcomes after percutaneous angioplasty for hepatic venous obstruction in liver transplant patients
Ammar Sarwar, Edward Ahn, Ian Brennan, Olga R Brook, Salomao Faintuch, Raza Malik, Khalid Khwaja, Muneeb Ahmed
Ammar Sarwar, Edward Ahn, Ian Brennan, Olga R Brook, Salomao Faintuch, Muneeb Ahmed, Divison of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States
Raza Malik, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States
Khalid Khwaja, Division of Transplant Surgery, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, United States
Author contributions: Sarwar A performed research study, collected data, analyzed data, wrote paper; Ahn E collected data, analyzed data, wrote paper; Brennan I designed research study, wrote paper; Brook OR analyzed data, wrote paper; Faintuch S, Malik R and Khwaja K performed research study, wrote paper; Ahmed M designed research study, performed research study, wrote paper.
Institutional review board statement: The study was reviewed and approved by the Institution Review Board at Beth Israel Deaconess Medical Center.
Informed consent statement: Since this was a retrospective report involving analysis of existing medical records and no investigator-initiated patient contact was performed, our institutional review board approved a waiver for informed consent.
Conflict-of-interest statement: None of the authors report and conflict of interest pertaining to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ammar Sarwar, MD, Divison of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, United States. asarwar@bidmc.harvard.edu
Telephone: +1-617-7542523
Received: March 30, 2015
Peer-review started: March 30, 2015
First decision: April 27, 2015
Revised: June 16, 2015
Accepted: July 11, 2015
Article in press: July 14, 2015
Published online: July 18, 2015
Processing time: 116 Days and 19.5 Hours
Abstract

AIM: To determine utility of transplant liver biopsy in evaluating efficacy of percutaneous transluminal angioplasty (PTA) for hepatic venous obstruction (HVOO).

METHODS: Adult liver transplant patients treated with PTA for HVOO (2003-2013) at a single institution were reviewed for pre/post-PTA imaging findings, manometry (gradient with right atrium), presence of HVOO on pre-PTA and post-PTA early and late biopsy (EB and LB, < or > 60 d after PTA), and clinical outcome, defined as good (no clinical issues, non-HVOO-related death) or poor (surgical correction, recurrent HVOO, or HVOO-related death).

RESULTS: Fifteen patients meeting inclusion criteria underwent 21 PTA, 658 ± 1293 d after transplant. In procedures with pre-PTA biopsy (n = 19), no difference was seen between pre-PTA gradient in 13/19 procedures with HVOO on biopsy and 6/19 procedures without HVOO (8 ± 2.4 mmHg vs 6.8 ± 4.3 mmHg; P = 0.35). Post-PTA, 10/21 livers had EB (29 ± 21 d) and 9/21 livers had LB (153 ± 81 d). On clinical follow-up (392 ± 773 d), HVOO on LB resulted in poor outcomes and absence of HVOO on LB resulted good outcomes. Patients with HVOO on EB (3/7 good, 4/7 poor) and no HVOO on EB (2/3 good, 1/3 poor) had mixed outcomes.

CONCLUSION: Negative liver biopsy greater than 60 d after PTA accurately identifies patients with good clinical outcomes.

Keywords: Hepatic venous outflow obstruction; Liver transplantation; Post-transplant biopsy; Angioplasty

Core tip: Percutaneous angioplasty and/or stent placement is the first-line of treatment in patients with hepatic venous obstruction (HVOO) after liver transplantation. Recognizing recurrence of HVOO after percutaneous treatment solely based on clinical, laboratory or imaging findings is difficult, and there is not a clear consensus regarding which measure provides the best or “gold standard” assessment for response to treatment. We report the utility of biopsy in predicting outcomes of percutaneous transluminal angioplasty (PTA) in patients with HVOO after liver transplantation. Specifically, we have found that patients without HVOO on a liver biopsy 60 d or more after PTA had no recurrence of HVOO on long-term follow-up.