Late graft hepatitis and fibrosis in pediatric liver allograft recipients: Current concepts and future developments
Top Cited Papers
- 26 October 2016
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Liver Transplantation
- Vol. 22 (11), 1593-1602
- https://doi.org/10.1002/lt.24616
Abstract
Liver transplantation (LT) in children now has a 20-year survival of >80%, but the longterm outcome of these grafts remains uncertain. Serial protocol liver biopsies after transplantation from several pediatric centres have demonstrated the gradual development of unexplained graft inflammation (“idiopathic” posttransplant hepatitis; IPTH) and graft fibrosis in biopsies obtained >12 months post-LT in children with good graft function and (near) normal liver biochemistry. Although the clinical significance of these findings is uncertain, there is evidence to suggest that IPTH may be a form of rejection or chronic antibody-mediated rejection as it is associated with the presence of auto/alloantibodies; de novo Class II donor-specific HLA antibodies (DSA); previous episodes of rejection, and may improve or be prevented with increased immunosuppression. Currently, the only method of diagnosing either hepatitis or fibrosis has been by serial protocol biopsies as neither serum markers of fibrosis nor noninvasive methods to detect fibrosis such as transient elastography (TE) are sufficiently validated in children. This review will focus on the diagnosis and management of idiopathic posttransplant hepatitis and graft fibrosis, discuss current methods for detecting graft injury, and potential mechanisms for their development. Liver Transplantation 22 1593–1602 2016 AASLD.Keywords
This publication has 69 references indexed in Scilit:
- Long-term medical management of the pediatric patient after liver transplantation: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of TransplantationLiver Transplantation, 2013
- Hepatitis E Virus: What Transplant Physicians Should KnowAmerican Journal of Transplantation, 2012
- Circulating microRNAs as biomarkers: A new frontier in diagnosticsLiver Transplantation, 2012
- Graft fibrosis in patients with biliary atresia after pediatric living‐related liver transplantationPediatric Transplantation, 2011
- Long-Term Patient Outcome and Quality of Life After Liver TransplantationAnnals of Surgery, 2010
- Proliferative alloresponse of T-cytotoxic cells identifies rejection-prone children with steroid-free liver transplantationLiver Transplantation, 2009
- Cytokeratin-18 fragment levels as noninvasive biomarkers for nonalcoholic steatohepatitis: A multicenter validation studyHepatology, 2009
- Graft fibrosis after pediatric liver transplantation: Ten years of follow-upHepatology, 2008
- Hyaluronic acid, an accurate serum marker for severe hepatic fibrosis in patients with non‐alcoholic fatty liver diseaseLiver International, 2005
- Outpatient Percutaneous Liver Biopsy in ChildrenJournal of Pediatric Gastroenterology and Nutrition, 1993