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Post-Transplant Events

The use of laparoscopic liver biopsies in pediatric patients with hepatic dysfunction following allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 36, pages 891–896 (2005)Cite this article

Summary:

Hepatic dysfunction following hematopoietic stem cell transplantation (HSCT) is common, but making the correct diagnosis can be challenging. Liver biopsies can serve as an important diagnostic tool when the etiology cannot be clearly determined by laboratory data, physical examination, and imaging studies. We reviewed 12 consecutive pediatric patients (seven males, five females, age 9–23 years) who received allogeneic HSCT and underwent a laparoscopic-guided liver biopsy for hepatic dysfunction of unknown etiology from 1998 to 2005. Biopsies were performed using a single-port technique with a 16 or 18 gauge, spring-loaded biopsy gun. The time from HSCT to biopsy ranged from 31 days to 821 days (median 92 days). No intra- or postoperative complications were observed. The initial clinical diagnosis was confirmed in seven patients, whereas the initial working diagnosis was inaccurate in the remaining five patients. Our results suggest that laparoscopic-guided liver biopsy is an informative and safe procedure in pediatric HSCT recipients; this approach helped delineate the true cause of hepatic dysfunction and changed our therapeutic approach in approximately 40% of the patients reviewed. While the safety record at our institution appears promising, a larger multi-institutional study would be necessary to more accurately describe the overall efficacy of this procedure in pediatric HSCT patients.

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Author notes

  1. J L M Ferrara: Dr Ferrara is a recipient of the Doris Duke Distinguished Clinical Scientist Award.

  2. K R Cooke: Dr Cooke is an Amy Strelzer-Manasevit Scholar of the National Marrow Donor Program, a Fellow of the Harold Amos Medical Faculty Development Program, a Leukemia and Lymphoma Society Scholar in Clinical Research and the recipient of a Clinical Scientist Award in Translational Research from the Burroughs Wellcome Fund.

Authors and Affiliations

  1. Departments of Pediatrics, Blood and Marrow Stem Cell Transplantation Program, University of Michigan, Ann Arbor, MI, USA

    S W Choi, J Levine, R Hutchinson, G Yanik, J L M Ferrara & K R Cooke

  2. Division of Pediatric Surgery, University of Mississippi, Jackson, MS, USA

    S Islam

  3. Department of Pathology, University of Michigan, Ann Arbor, MI, USA

    J K Greenson

  4. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    D H Teitelbaum

Authors
  1. S W Choi
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  2. S Islam
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  3. J K Greenson
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  4. J Levine
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  5. R Hutchinson
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  6. G Yanik
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  7. D H Teitelbaum
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  8. J L M Ferrara
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  9. K R Cooke
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Corresponding author

Correspondence to K R Cooke.

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Choi, S., Islam, S., Greenson, J. et al. The use of laparoscopic liver biopsies in pediatric patients with hepatic dysfunction following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 36, 891–896 (2005). https://doi.org/10.1038/sj.bmt.1705158

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  • DOI: https://doi.org/10.1038/sj.bmt.1705158

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