{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:16:48Z","timestamp":1791393408253,"version":"4.3.3"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2009,8,1]],"date-time":"2009-08-01T00:00:00Z","timestamp":1249084800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2009,7,29]],"date-time":"2009-07-29T00:00:00Z","timestamp":1248825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2009,8]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>As outcomes from liver transplantation have improved, attention has focused on long-term outcomes: patient and graft survival is affected by many factors, including the consequences of both overimmunosuppression (eg, renal failure and cancer) and underimmunosuppression (eg, rejection). The use of protocol (rather than event-driven) biopsies of the liver allograft, except for those grafted for HCV infection, has been largely abandoned. The aim of this study was to determine if protocol biopsies can improve the management of liver allograft recipients. A retrospective analysis of liver allograft recipients who had undergone protocol liver biopsies between 2000 and 2006 was performed. One hundred seventy-eight patients with normal liver tests (alcoholic liver disease, 49; autoimmune hepatitis, 20; and primary biliary cirrhosis, 107) who had undergone 235 protocol biopsies were identified. No significant complication from the biopsy was recorded. Liver histology was reported as normal or nearly normal in only 57 (24%). Chronic hepatitis (not obviously related to disease recurrence) was present in 78 (33%). Interpreted in the light of the calculated creatinine clearance, the biopsy findings indicated that overall immunosuppression (IMS) should be maintained or increased with standard calcineurin inhibitor (CNI)\u2013based IMS in 25% of cases, that overall IMS should be reduced in 15% of cases, and that overall IMS should be maintained or increased by the substitution of non-nephrotoxic agents for CNIs in 9% of cases. The histological findings led to a documented change in IMS in 76 (32%) (increased IMS, 11; decreased IMS, 58; and switch from CNI, 7). In conclusion, protocol liver biopsy provides important histological information about graft function that is not available from standard liver tests and safely allows modification of IMS to ensure that long-term side effects of drug therapy (eg, renal failure) are minimized while graft function is sustained. Liver Transpl 15:931\u2013938, 2009. \u00a9 2009 AASLD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/lt.21781","type":"journal-article","created":{"date-parts":[[2009,7,29]],"date-time":"2009-07-29T15:41:50Z","timestamp":1248882110000},"page":"931-938","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":75,"title":["Late protocol liver biopsies in the liver allograft: A neglected investigation?"],"prefix":"10.1097","volume":"15","author":[{"given":"George","family":"Mells","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Mann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Hubscher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Neuberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-14-20250326","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/j.lts.2003.09.018","article-title":", and the European Liver Transplant Association. Evolution of liver transplantation in Europe: report of the European Liver Transplant Registry.","volume":"9","author":"Adam","year":"2003","journal-title":"Liver Transpl"},{"key":"R2-14-20250326","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1097\/01.tp.0000262706.28513.6a","article-title":"Reducing the risks of cardiovascular disease in liver allograft recipients.","volume":"83","author":"Mells","year":"2007","journal-title":"Transplantation"},{"key":"R3-14-20250326","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1056\/NEJMoa021744","article-title":"Chronic renal failure after transplantation of a nonrenal organ.","volume":"349","author":"Ojo","year":"2003","journal-title":"N Engl J Med"},{"key":"R4-14-20250326","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1016\/S0041-1345(98)01994-0","article-title":"Incidence and outcome of de novo malignancies after liver transplantation.","volume":"31","author":"Galve","year":"1999","journal-title":"Transplant Proc"},{"key":"R5-14-20250326","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1053\/jlts.2001.23794","article-title":"Are posttransplantation protocol liver biopsies useful in the long term?","volume":"7","author":"Berenguer","year":"2001","journal-title":"Liver Transpl"},{"key":"R6-14-20250326","first-page":"195","article-title":"Graft and systemic disease in longterm survivors of liver transplantation.","volume":"25","author":"Slapak","year":"1997","journal-title":"Hepatology"},{"key":"R7-14-20250326","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1097\/PAS.0b013e3181622490","article-title":"Histologic abnormalities are common in protocol liver allograft biopsies from patients with normal liver function tests.","volume":"32","author":"Abraham","year":"2008","journal-title":"Am J Surg Pathol"},{"key":"R8-14-20250326","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1002\/hep.1840120535","article-title":"Chronic hepatitis in liver allografts.","volume":"12","author":"Hubscher","year":"1990","journal-title":"Hepatology"},{"key":"R9-14-20250326","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1002\/hep.21152","article-title":"Progressive histological damage in liver allografts following paediatric liver transplantation.","volume":"43","author":"Evans","year":"2006","journal-title":"Hepatology"},{"key":"R10-14-20250326","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1002\/lt.21108","article-title":"Natural history of unexplained chronic hepatitis after liver transplantation.","volume":"13","author":"Syn","year":"2007","journal-title":"Liver Transpl"},{"key":"R11-14-20250326","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1002\/hep.510250435","article-title":"Posttransplantation chronic hepatitis in fulminant hepatic failure.","volume":"25","author":"Mohamed","year":"1997","journal-title":"Hepatology"},{"key":"R12-14-20250326","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1002\/lt.21202","article-title":"Idiopathic posttransplantation hepatitis?","volume":"13","author":"Shaikh","year":"2007","journal-title":"Liver Transpl"},{"key":"R13-14-20250326","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1002\/hep.21280","article-title":"Liver biopsy interpretation for causes of late allograft dysfunction.","volume":"44","year":"2006","journal-title":"Hepatology"},{"key":"R14-14-20250326","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1002\/lt.21444","article-title":"Interface hepatitis is associated with a high incidence of late graft fibrosis in a group of tightly monitored pediatric orthotopic liver transplantation patients.","volume":"14","author":"Herzog","year":"2008","journal-title":"Liver Transpl"},{"key":"R15-14-20250326","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1097\/TP.0b013e318176b1fd","article-title":"Protocol liver allograft biopsies.","volume":"85","author":"Mells","year":"2008","journal-title":"Transplantation"},{"key":"R16-14-20250326","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/S0168-8278(05)80244-2","article-title":"Primary biliary cirrhosis. Histological evidence of disease recurrence after liver transplantation.","volume":"18","author":"Hubscher","year":"1993","journal-title":"J Hepatol"},{"key":"R17-14-20250326","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1053\/jlts.2001.23085","article-title":"Recurrent autoimmune hepatitis after liver transplantation: diagnostic criteria, risk factors, and outcome.","volume":"7","author":"Hubscher","year":"2001","journal-title":"Liver Transpl"},{"key":"R18-14-20250326","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1016\/S0041-1345(98)00332-7","article-title":"Protocol liver biopsies: the case in favour.","volume":"30","author":"Neuberger","year":"1998","journal-title":"Transplant Proc"},{"key":"R19-14-20250326","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/00000478-199502000-00008","article-title":"Structural integrity and identification of causes of liver allograft dysfunction occurring more than 5 years after 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