Diagnostic Yield of Transjugular Liver Biopsy Samples to Evaluate for Infectious Etiology of Liver Dysfunction in Bone Marrow Transplant Recipients

Abstract

To determine the diagnostic yield of transjugular liver biopsy (TJLBx) samples to evaluate for infectious etiology (immunosuppressed protocol [ISP] of TJLBx) in bone marrow transplant (BMT) recipients. A retrospective review of 78 TJLBx in 61 patients who had undergone BMT was undertaken. Biopsy was performed with an automated 19-gauge needle set. The primary indication was suspected graft-versus-host disease in all; a subset also sought to detect infectious liver pathology. In these (n = 31 biopsy samples, 22 patients), an ISP was used with tissue sent for bacterial, viral, fungal, and mycobacterial analysis in addition to histology. In the remainder (n = 47 biopsy samples, 41 patients), tissue was sent for histology only (H). Sample adequacy, histological diagnosis, microorganism assay results (ISP), and complications were reviewed. To assess sample adequacy in BMT compared to non-BMT patients, random control sample of 77 biopsy samples in 75 inpatients during the same period was reviewed (C). All but 1 TJLBx (C group) were technically successful (99%). One major (ISP) and 5 minor complications occurred (H = 3, ISP = 1, C = 1). There were 3 inadequate specimens (6.4%) in the H group, 4 in the ISP group (12.9%), and 4 in the C group (5.2%) (p = NS). No organisms were isolated in any ISP biopsy samples (yield 0%). When ISP is requested in BMT recipients, biopsy yields were lower, for unclear reasons possibly relating to degree of liver injury. ISP adds no useful positive information over histology alone. The value of negative cultures in this population is unclear.