biopsy after transplant

Dear Sir,

My son (9 yrs now) went thrrough Liver Transplant on June 3rd, 2008. He was CMV positive 3 months post transplant and his biopsy was done and no abnormality was found. Now doctor says that it is mandatory to go for biopsy again 1 year post transplant.Could you please tell me if it is really necessary, all his liver tests are normal like alt and ast are 29 and 19 respectively and normal since last 4 months. Only globulin is fluctuating between 4.5  and 5gm/dl( normal range is between 1.8 - 3.6) .Also his IgG is elvated 2300 mg/de ( normal range between 650-1600). Also he is recently detected EBV positive.

Please let me know if biopsy at this stage is required and it is a general practice to get biopsy after one year post transplant. Also will it give some guidelines to treat EBV positive and elevated  IgG and Globilin

[Thomas D Schiano, MD]

this sounds like a protocol biopsy but frankly its not unreasonable in the pediatric setting because of the EBV issue and some times a chronic hepatitis can develop and smolder and cause significant liver damage over time.  an elevated IgG might be seen in this setting.