A258 HISTOLOGICAL FINDINGS IN PROTOCOL BIOPSIES FOLLOWING PAEDIATRIC LIVER TRANSPLANTATION: LOW INCIDENCE OF ABNORMALITIES WITH TACROLIMUS MONOTHERAPY AT FIVE YEARS
Bibliographic record
Abstract
Histological abnormalities (chronic hepatitis, fibrosis & steatosis) are increasingly reported in liver biopsies of children after liver transplantation (LT). These changes may be progressive & represent a form of rejection. Liver biochemistry is often initially normal. The LT programme in New Zealand began in 2002, utilising tacrolimus and low-dose steroids for the first year. Patients undergo a protocol biopsy at one year post LT prior to stopping steroids, then at 5 yrs and every 5 yrs thereafter. Target tacrolimus levels are 5–8 g/L and 3–5 g/L after 3 and 12 months respectively. The evaluate the incidence and characteristics of histological abnormalities in protocol biopsies at 1 and 5 yrs post paeditric LT in a cohort of patients on predominantly tacrolimus monotherapy Between 2002–2009, 51 children underwent LT; 50 (98%) and 49 (96%) patients survived for 1 and 5 yrs respectively. 41 patients (median age at LT 2.3 yrs) underwent a protocol biopsy at 1yr (16 male; median time post LT 12.5 months), and 43 (20 male; median time post LT 5.1 yrs) at 5 yrs. By 5 yrs, 3 had transferred to adult services; 1 was re-transplanted for graft failure & 1 moved overseas. Most patients (30/43) were on tacrolimus monotherapy at 5 yrs. At 1 & 5 yrs 29/41 (71%) & 29/43 (67.5%) biopsies were normal respectively. 2/43 had chronic immune hepatitis at 5 yrs. 1/41 & 3/43 had fibrosis, 3/41 & 3/43 steatosis, and 2/41 and 3/43 acute rejection at 1 & 5 years respectively. Other findings included predominantly biliary changes (6/41 & 2/43 at 1 & 5 yrs respectively). Tacrolimus levels at 5 yrs were slightly higher than anticipated (median trough level 5.1 g/L). With an immunosuppressive regimen of tacrolimus and low dose steroids for 1 year followed by tacrolimus monotherapy thereafter, the majority of protocol liver biopsies were normal and no progressive changes were observed at 5 yrs. Compared to other LT programmes, we have reduced rates of chronic allograft hepatitis, steatosis and fibrosis at 5 yrs. However, the tacrolimus levels at 5 yrs were higher than planned & this may have played a role. Further evaluation is also required to determine the potential long-term adverse effects of corticosteroid use on linear growth and bone mineral density RESULTS None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".