Transjugular Biopsy Results in the Transplanted Liver: Comparison of Two Surgical Hepatic Venous Anastomotic Configurations in 269 Consecutive Biopsies over a 14-year Period

Abstract

To compare the results of transjugular liver biopsy in patients who have undergone liver transplantation via an inline versus a "piggyback" hepatic venous surgical anastomosis. From October 1994 to July 2008 (165 months), 269 consecutive transjugular liver biopsy procedures were performed on 139 patients (94 male patients underwent 194 procedures) who had received cadaveric liver transplantation. Mean patient age at the time of the biopsy was 46.9 years (range, 1-71 y). There were 131 biopsy procedures on patients with an inline hepatic venous anastomosis and 138 on patients with a piggyback anastomosis. Records were reviewed for patient demographic data, surgical configuration of hepatic venous anastomosis, laboratory and procedural data, complications, and surgical pathologic findings. Among 269 biopsy procedures, 257 (95.5%) produced a diagnostic tissue specimen based on pathology reports and were deemed successful procedures. Catheterizing the hepatic veins and obtaining a diagnostic tissue sample significantly favored the inline anastomotic configuration (129 of 131; 98%) versus the piggyback configuration (128 of 138; 93%; P = .035). The difference between groups in the inability to cannulate the hepatic veins (0.8% vs 4%) was not significant (P = .12), nor was the incidence of pathologically insufficient tissue when cannulation and biopsy was performed (0.8% vs 0.3%; P = .37). There were two major complications consisting of hemorrhage that contributed to a patient's death in each group. Transjugular liver biopsy is less likely to yield diagnostic tissue when the hepatic venous anastomosis has a piggyback configuration. However, the procedure is equally safe and possesses acceptable tissue yields with a piggyback or inline configuration.