Abstract No. 24: Does an immunosuppressed protocol add diagnostic information to transjugular biopsy in bone marrow transplant recipients?

Abstract

1) To determine contribution of an immunosuppressed protocol (ISP) to transjugular liver biopsy (TJLBx) in bone marrow transplant (BMT) recipients and 2) to evaluate outcomes of TJLBx in BMT recipients. A retrospective review of all inpatient TJLBx from July 2001 to November 2009 (n=785) was conducted. 78 TJLBx were performed in 61 patients who had received BMT. Biopsy was performed using a 19G Quick-Core set (Cook, Bloomington, IN). Primary indication was suspected graft versus host disease (GVHD) in all; a subset also sought to detect infectious liver pathology found in BMT patients. In these (n=31 in 22 patients), an immunosuppressed protocol (ISP) was used with tissue sent for bacterial, viral, fungal, and mycobacterial cultures in addition to histology. In the remainder (n=47 in 41 patients), tissue was sent for histology only (H). Sample adequacy, histological diagnosis, culture results (ISP), time from transplant to biopsy, and complications were reviewed (Table). To assess TJLBx sample adequacy in BMT vs non-BMT patients, a random sample of 77 biopsies in 75 inpatients during the same period was reviewed (C).Tabled 1GroupMale (% of patients)Mean age (yrs)Time from BMT (months)Minor complications (% of bx)Major complications (% of bx)Specimen adequate (% of bx)Culture positiveNormal biopsy (% of bx)GVHD (% of bx)Malignancy (% of bx)Other (% of bx)ISP/BMT (ISP)15 (68%)487.11 (3%)1 (3%)87%0%5 (16%)16 (52%)0 (0%)6 (19%)Non-ISP BMT (H)27 (66%)458.73 (6%)0 (0%)94%N/A8 (17%)18 (38%)3 (6%)15 (32%)Control (C)33 (44%)52N/A1 (1%)0 (0%)95%N/A Open table in a new tab All but 1 (C) TJLBx were technically successful (99%). 1 major (SIR definitions) complication (hemoperitoneum, ISP) and 5 minor complications occurred: oversedation (H, n=1), symptomatic bradycardia (C, n=1), access site bleeding (ISP and H, n=1 each), and tunneled catheter puncture (H, n=1). Biopsy results are shown in the Table. There were 3 inadequate specimens (6.4%) in the H group, 4 in the ISP group (12.9%) and 3 in the C group (5.2% including technical failure) (P=NS). No organisms were cultured in any ISP biopsies (yield 0%); 2 gram stains were positive (1 GNR and 1 leukocytes) with negative culture. When ISP is requested in BMT recipients, biopsy yields trend lower, for unclear reasons possibly relating to degree of liver injury. ISP adds little or no useful positive information over histology alone in BMT patients; the value of negative cultures is unclear.