Low-dose steroids associated with milder histological changes after pediatric liver transplantation.
Controversy remains about the role of protocol liver biopsies of symptom-free recipients and long-term use of low-dose steroids after pediatric liver transplantation. We conducted a national cross-sectional study of pediatric recipients who underwent liver transplantation between 1987 and 2007. Liver biopsies were taken from 54 patients (82% of survivors) after a median follow-up of 11 years post-transplant, and reviewed by two pathologists blinded to clinical data. Biopsies of 18 patients (33%) showed near-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 those 35 patients whose immunosuppression included steroids (14% vs. 47%; p=0.008). Fibrosis was present in 21 biopsies (39%). According to the Metavir classification, 16 were stage 1, three stage 2, and two 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=0.529, p<0.001) and portal inflammation (r=0.350, p=0.010). Microvesicular steatosis was found in 23 biopsies (43% of patients, 5-80% of hepatocytes), and correlated with the patients' body-mass-index (r=0.458, p<0.001), but not with steroid use. The age of the allograft (donor age + follow-up time) correlated with higher serum gamma-glutamyl transferase (r=0.472, p7t0.001), conjugated bilirubin levels (r=0.420, p=0.002), as well as chronic cholestasis (r=0.299, p=0.033). The biopsy findings led to treatment changes in 10 patients (19%), while only one complication (subcapsular hematoma) was encountered. Conclusion: Continuing low-dose steroids indefinitely after pediatric liver transplantation may have a positive effect on the long-term histological state of the liver graft. Allograft ageing may lead to chronic cholestasis thus contributing to the development of liver fibrosis. © 2012 American Association for the Study of Liver Diseases. Copyright © 2012 American Association for the Study of Liver Diseases.