DIAGNOSIS OF HEPATIC ALLOGRAFT-REJECTION - ROLE OF LIVER-BIOPSY

The role of the liver biopsy for establishing a diagnosis of liver all ograft rejection was investigated by examining under code 151 liver bi opsies from 32 recipients and correlating the results with the clinica l diagnosis determined by chart review. One-hundred-and-four biopsies were obtained to evaluate the cause of liver dysfunction and 47 were p erformed on a weekly protocol basis independent of the clinical status . A diagnosis of ''definite histologic rejection'' was made if a biops y contained portal triaditis, bile duct injury, and endothelialitis, w hile biopsies were said to be suspicious for rejection if portal triad itis and bile duct injury were evident. A diagnosis of rejection using clinical and biochemical findings and response to therapy was made in association with 37 biopsies, of which 16 had definite histologic rej ection and 13 were suspicious for rejection. Of the 114 biopsies perfo rmed in patients without clinical rejection, 71 had histology suspicio us for rejection. Thus, biopsy was sensitive for the detection of reje ction (78%), but was not very specific (33%). The positive predictive value was low (28%), while the negative predictive value was high (83% ). These results indicate that liver biopsy is useful to evaluate graf t dysfunction, to exclude rejection, to confirm clinically suspected r ejection, and to diagnose other problems that can affect allograft fun ction. Protocol biopsies appear to have little value.