Utility of liver biopsy in predicting clinical outcomes after percutaneous angioplasty for hepatic venous obstruction in liver transplant patients

AIM: To determine utility of transplant liver biopsy in evaluating efficacy of percutaneous transluminal angioplasty(PTA) for hepatic venous obstruction(HVOO). METHODS: Adult liver transplant patients treated with PTA for HVOO(2003-2013) at a single institution were reviewed for pre/post-PTA imaging findings, manometry(gradient with right atrium), presence of HVOO on prePTA and post-PTA early and late biopsy(EB and LB, < or > 60 d after PTA), and clinical outcome, defined as good(no clinical issues, non-HVOO-related death) or poor(surgical correction, recurrent HVOO, or HVOOrelated death). RESULTS: Fifteen patients meeting inclusion criteria underwent 21 PTA, 658 ± 1293 d after transplant.In procedures with pre-PTA biopsy(n = 19), no difference was seen between pre-PTA gradient in 13/19 procedures with HVOO on biopsy and 6/19 procedures without HVOO(8 ± 2.4 mm Hg vs 6.8 ± 4.3 mm Hg; P = 0.35). Post-PTA, 10/21 livers had EB(29 ± 21 d) and 9/21 livers had LB(153 ± 81 d). On clinical follow-up(392 ± 773 d), HVOO on LB resulted in poor outcomes and absence of HVOO on LB resulted good outcomes. Patients with HVOO on EB(3/7 good, 4/7 poor) and no HVOO on EB(2/3 good, 1/3 poor) had mixed outcomes. CONCLUSION: Negative liver biopsy greater than 60 d after PTA accurately identifies patients with good clinical outcomes.