410. Hepatic Dysfunction in Allogeneic Hematopoietic Stem Cell Transplant (HSCT) Recipients: Role of Liver Biopsy (LBx) and Risk of Voriconazole Use
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Liver dysfunction after allogeneic HSCT is common and may be related to graft versus host disease (GVHD), veno-occlusive disease (VOD), iron overload, infection or drug toxicity. With recent increase in use of voriconazole for mould prophylaxis and treatment, it is unclear if there is an increased frequency of LBx consequent to suspected drug related hepatotoxicity. The diagnostic value of the liver biopsy and its impact on the clinical management in this patient population is poorly defined.
Methods: A retrospective analysis of data was done on patients who underwent allogeneic HSCT from January 1, 2001 to December 31, 2008 from the Karmanos Cancer Institute database and all patients who had a liver biopsy were included.
Results: Incidence of liver biopsy steadily increased during the study period (11% in 2001, 20% in 2004, 24% in 2008). A total of 106 patients underwent LBx through transjugular (TJ) approach and 3 had percutaneous biopsy. Most patients (93/109) had not received voriconazole. All biopsies yielded optimal tissue samples. The predominant histological diagnosis was a combination of GVHD and iron overload of varying severity. No cases of VOD, infection or drug related toxicity was seen including in the 16 patients who received voriconazole. The results of LBx were helpful in the successful management of 87 out of 109 patients. Only two patients had complications namely, subcapsular liver hematoma after TJ approach, one of whom required blood transfusion.
Conclusion: LBx in HSCT, obtained via TJ approach is safe, has satisfactory yield and when obtained, helps in the management of most patients. Increase in the frequency of LBx is not attributable to voriconazole use. Improvements in obtaining LBx by TJ approach may explain the increasing incidence of LBx in this study.
George Alangaden, MD1, Zaid Al-Kadhimi, MD2, Karanpreet Bains, MD2, Pranatharthi Chandrasekar, MD3, Mayur Ramesh, MD4 and  M. S. Ramesh, None..
K. Bains, None..
G. Alangaden, None..
Z. Al-Kadhimi, None..
P. H. Chandrasekar, None., (1)Detroit Medical Center/Wayne State University, Detroit, MI, (2)Wayne State University, Detroit, MI, (3)Detroit Medical Center/Wayne State University, BMT Team, Detroit, MI, (4)Henry Ford Health System, Detroit, MI