Protocol liver biopsy is the only examination that can detect mid-term graft fibrosis after pediatric liver transplantation

Figure 1 Receiver operating characteristic curve analysis of the alanine amino transaminase level at two years after living donor liver transplantation in the patients with a score of ≥ A1. The recommended cutoff value for diagnosing a score of ≥ A1 was set at 20 IU/L (sensitivity: 50.0%, specificity: 76.1%, area under the curve: 0.685 and 95%CI: 0.557-0.813).

Figure 2 In postoperative year 5, a protocol liver biopsy was performed. A: At which time the Metavir scores were abnormal: A2 (portal inflammation) and F2 (portal and pericellular fibrosis); B: Follow-up liver biopsy was performed at 18 mo after the protocol liver biopsy (PLB), at which time the scores were A0 and F0; C: At which time the Metavir scores were abnormal: A2 (portal inflammation) and F2 (portal fibrosis); D: A follow-up liver biopsy was performed at 20 mo after the PLB, at which time the scores were A1 (portal inflammation) and F0. HE: Hematoxylin and eosin stain; AZAN: Azan stain.