Complications Of Liver Biopsy Research Articles

Phase 1 Trial Results for Patients with Advanced Hematologic Malignancies Undergoing Reduced Intensity Allogeneic HCT with Orca-T Donor Cell Therapy Product and Single Agent Tacrolimus

Introduction: Reduced intensity conditioning hematopoietic bone marrow stem cell transplantation (HSCT-RIC) is the only curative option for many hematological malignancies in older/unfit patients. Strategies to minimize complications such as graft versus host disease (GVHD) in HSCT include donor graft engineering but this approach has not been widely tested to the RIC setting due to a potential trade-off between engraftment and reduced GVHD with T cell depletion strategies. Here we present the interim results of our single center Phase I trial evaluating the T cell reduced Orca-T cell therapy product and single agent tacrolimus in the RIC setting. Methods: The trial is a single-center open-label phase 1 feasibility and safety study for dose escalation of conventional T cell (Tcon) infusion. Primary objectives included measuring the incidence of grade III-IV acute GVHD, time of engraftment and donor T cell chimerism at day +30. Secondary objectives are measuring relapse free survival, severity of GVHD and incidence of serious infections. While the study has three independent trial arms depending on donor type (HLA matched related and unrelated, 9/10 HLA matched or haploidentical matched), accrual has focused on the HLA-matched cohort which is reported here. The first 11 patients on this arm were conditioned with fludarabine 40mg/m 2, melphalan 50 mg/m 2 and 4 Gy of total body irradiation (TBI), an additional 4 patients have been treated with thiotepa 10 mg/kg replacing the melphalan. All patients received single agent tacrolimus with a target goal of 6-8 ng/ml. Results: A total of 15 HLA-matched patients have been recruited thus far in this interim dose escalation analysis. The median patient age is 68.0 years (range 62 to 72), with 73% male (11/15) patient distribution. Pre transplant, 53% had acute myeloid leukemia (8/15), 20% had myelodysplastic syndrome (3/15), 13% had acute lymphoblastic leukemia (2/15) and 13% had a myeloproliferative neoplasm (2/15). Prior to transplant, all acute leukemia patients were in complete remission (CR) or CR with incomplete count recovery. Median follow up was 10.4 months for the entire cohort (range 2 to 20 months). 14/15 patients had engraftment by day 20 and 1/15 at day 39 post-transplant. Based on these findings, no dose escalation of Tcon infusion was needed. None of the patients had infusion reactions on day of transplant nor engraftment syndrome. Median percent donor chimerism for CD15 was high, with 100% at day 30 (15/15, range 94% to 100%) and 99% (13/15, patients with available data, range 98% to 100%) at day 90. Median CD3 chimerism at days 30 and 90 of transplant were also high at 99% (15/15, range 68% to 100%) and 99% (for 13/15 patients with available data, range 78% to 100%) respectively. No patients developed grade III-IV acute GVHD ( Fig.), defined <100 days post-transplant. One patient developed grade II aGVHD. In 12 months, the incidence for moderate to severe chronic GVHD was 7%. The 12-month relapse free survival (RFS) is thus far 79% ( Fig.). The cumulative incidence for grade 2 and 3 infections in the first 90 days was 26.7%, where 2 patients died. One patient died at day 180 from liver biopsy complications for late onset hepatic sinusoidal obstruction syndrome. No surviving patient has had disease relapse. Conclusions: These early results demonstrate that Orca-T is a safe and feasible transplant strategy in the RIC setting for patients with advanced hematological malignancies. Patients showed robust and early donor myeloid and eventual full donor T cell engraftment. The low incidence of acute and chronic GVHD with low rates of disease relapse, suggest retention of graft versus leukemia effect. Few studies of donor graft-engineered products have been successfully evaluated in the RIC setting and merits larger multicenter studies evaluatingGVHD-free and RFS post-transplant to validate these findings.

Hepatitis delta virus: Disease assessment and stratification.

Hepatitis D virus (HDV) causes one of the most severe forms of hepatitis in people with chronic hepatitis B (CHB) infection. Timely and accurate assessment of hepatitis delta virus (HDV) and disease stratification is mandatory for thorough pre-therapeutic evaluation for prioritizing treatment and outcome prediction. Viral biomarkers associated with HDV and hepatitis B virus (HBV) are crucial to aid in diagnosis, and monitoring of serum viral nucleic acids for both viruses is recommended. Liver biopsy remains the gold standard for staging of liver fibrosis and grading of histological activity and should remain central for diagnostic purposes, but is also of importance for research to enhance our understanding of HDV. The emergence of novel non-invasive tests for the assessment of liver fibrosis in HDV patients coupled with the well-recognized potential complications of liver biopsy has resulted in reduced utility of liver biopsy in clinical practice. Preliminary data suggest that these emerging non-invasive modalities appear to be reliable, and their use is supported, similar to other viral hepatitis. Nevertheless, further validation is required before their widespread adoption into clinical practice.

Immediate postoperative color Doppler ultrasonography on the diagnosis of hemorrhagic complications of liver biopsy and its directed compression hemostasis

Objective: To study the diagnostic value of immediate color Doppler ultrasonography on traumatic hepatic hemorrhage after tissue sampling with ultrasound-guided liver biopsy and the clinical effect of its-directed local compression hemostasis at puncture-site. Methods: 132 hospitalized patients with various liver diseases underwent ultrasound-guided hepatic puncture-biopsies, including 61 cases with diffuse parenchymal and 71 cases with focal liver lesions. Immediate postoperative color Doppler ultrasonography was performed following liver biopsy. Abnormal blood flow signal was observed at hepatic puncture biopsy site, and if there were hemorrhagic signals, ultrasound-directed local compression hemostasis was performed until the bleeding signal disappeared. F-test and Chi-square test were used for statistical analysis. Results: Immediate color Doppler ultrasonography showed traumatic hemorrhage in 36.1% (22/61) and 40.8% (29/71) cases of diffuse liver disease and focal liver disease group, respectively. All hemorrhagic signals were eventually disappeared after ultrasound-directed local compression hemostasis. The median hemostasis time was 2 min in both groups, and there was no statistically significant difference in bleeding rate and hemostasis time between the two groups (P>0.05). There were no serious complications and deaths. Conclusion: Traumatic hepatic hemorrhage along the needle puncture tract is a common accompanying condition during liver biopsy. Immediate postoperative color Doppler ultrasonography can trace bleeding signals in timely manner and direct effective compression hemostasis, so it should be used routinely to help avoid occurrence of severe hemorrhagic complications.

Autotaxin as a Marker for Liver Fibrosis in Chronic HCV Patients

ABSTRACT: Background: Chronic hepatitis C is a major health problem. Noninvasive markers were developed to overcome liver biopsy complications. Autotaxin (ATX) is a lysophospholipase D enzyme that regulates lysophosphatidic acid (LPA) blood concentrations. Studies have suggested that the phenotypic changes during liver fibrosis may lead to changes in ATX level in the serum. Objectives: to determine the serum Autotaxin levels and its correlation to the liver fibrosis and whether it can be used as a non-invasive diagnostic biomarker of fibrosis in Egyptian Chronic viral hepatitis C individuals. Methodology: This study was conducted on 40 patients divided into 2 groups: Group I comprised of 20 patients with chronic viral hepatitis C patients in compensated stage and Group II comprised of 20 patients with chronic viral hepatitis C patients in decompensated stage together with 20 apparently healthy controls group. All patients were subjected to the following: complete history taking، complete clinical examination، routine lab investigations، abdominal ultrasound and measurement of serum ATX level detected by ELISA technique. Results: 40 patients were enrolled. Serum ATX was significantly higher according to liver fibrosis worsen stage (p=0.002) ،ATX was significantly higher in decompensated chronic hepatitis C patients (CHC) compared to patients with compensated CHC and controls with mean values (646.7 ± 247.4) ، (615.3 ± 266) and (469.9 ± 62.3) ng/ml respectively (p=0.005). Conclusion: Autotaxin was shown to be a potential serum marker for estimating the degree of fibrosis in patients with chronic HCV.

S3523 Rare Complication of Liver Biopsy

INTRODUCTION: Bleeding from the hepatobiliary tract is an unusual cause of the acute upper gastrointestinal bleed. Liver biopsy is deemed a safe and highly effective procedure to diagnose numerous liver conditions. Since its introduction at the end of the 19th century, modern imaging methods, special needles, and clinical experience have significantly reduced the rate of complications associated with liver biopsy. Hemoperitoneum, sub-capsular hematoma, pneumothorax, sepsis, and haemobilia are rare complications associated with liver biopsy. We are presenting a case of haemobilia, which resulted as a complication of liver biopsy and its management. CASE DESCRIPTION/METHODS: A 62-year-old male presented after an episode of hematemesis, severe right upper abdominal pain, jaundice, and melena after transjugular liver biopsy for evaluation of autoimmune hepatitis. Abdominal ultrasound showed dilated common bile duct (CBD), indicating biliary obstruction. Upper endoscopy, however, showed no signs of ongoing or old bleeding. These findings were followed by endoscopic retrograde cholangiopancreatography (ERCP) with discovery of blood clots in the CBD, revealing the diagnosis of haemobilia. The blood clots were removed and followed by placement of a plastic stent in the CBD. The patient, however, underwent a repeat ERCP with replacement of CBD stent as he continues to have melena requiring multiple blood transfusions. After the deployment of metal stent, patient's abdominal pain started to improve and his hemoglobin level stabilized. The third ERCP was performed 4 days later, which confirmed the resolution of haemobilia. The patient's symptoms continued to improve and was discharged after 29 days of hospitalization. DISCUSSION: Percutaneous or transjugular liver biopsies are performed very frequently for evaluation of causes of liver conditions in a safe and effective way. Complications associated with liver biopsy are uncommon, but severe complications do occur. Our case illustrates a distinctive way of managing such rare complication with advanced techniques like biliary stenting.

S1529 Occult Portobiliary Fistula Following Percutaneous Liver Biopsy

INTRODUCTION: Percutaneous liver biopsies are commonly performed procedures in the diagnostic workup or staging of liver diseases, and bleeding is the most important complication. Hemobilia is defined as bleeding into the biliary tree, and is a rare complication of liver biopsy that classically presents with a triad of GI bleeding, abdominal pain, and jaundice. CASE DESCRIPTION/METHODS: A 44-year-old male underwent an uneventful liver biopsy for workup of hepatic steatosis. The next day he presented to the ER with RUQ abdominal pain and jaundice. Vital signs were normal and physical examination revealed scleral icterus and epigastric tenderness. Liver function tests showed AST and ALT of 2248 U/L and 2915 U/L, respectively, alkaline phosphatase of 200 U/L, and total bilirubin of 23.3 mg/dL with direct bilirubin of 13.9 mg/dL. CT scan revealed small hemoperitoneum and diffuse hepatic steatosis. Ultrasound with doppler showed normal biliary and intrahepatic ducts and patent portal and hepatic veins with normal blood flow. On the fourth hospital day, MRCP revealed moderate right intrahepatic biliary ductal dilatation with associated hemobilia to the level of the biliary confluence (Figure 1). MRI with contrast revealed completely thrombosed right portal vein and branches, and persistent right intrahepatic biliary ductal dilatation (Figure 2). Oral anticoagulation was considered; however, the gastroenterology team felt the liver biopsy caused an iatrogenic portobiliary fistula, leading to the formation of the portal vein thrombus which may have helped seal the fistula. Therefore, the decision was made to hold anticoagulation and discharge the patient. Liver function tests one month later revealed AST and ALT of 20 U/L and 70 U/L respectively. Repeat MRI showed a reduction of right intrahepatic biliary dilation, and chronic right portal vein thrombus with recanalization and mild cavernous transformation (Figure 3). DISCUSSION: Given the biliary dilation on MRCP, we suspect that a blood clot at the biliary confluence caused an obstruction leading to acute severe rise in AST, ALT and direct hyperbilirubinemia. Due to the risk of further bleeding and possible tamponade effect of clot, anticoagulating the patient may have worsened the situation. Portobiliary fistulas leading to hemobilia are a rare complication of percutaneous liver biopsy. While GI bleeding, jaundice, or abdominal pain post-biopsy should prompt a diagnostic workup, it should also be kept in mind that there could be uncommon presentations of hemobilia.Figure 1.: MRCP showing moderate right intrahepatic biliary ductal dilatation with associated hemobilia.Figure 2.: Contrast enhanced MRI showing thrombosed right portal vein and branches, and right intrahepatic biliary ductal dilatation.Figure 3.: Follow-up MRI showing reduction of right intrahepatic biliary dilation, and chronic right portal vein thrombus.

Complications of Ultrasound-guided Liver Biopsy at a Tertiary Care Hospital in Pakistan: An Audit.

IntroductionLiver diseases account for two million deaths per year worldwide, half of which are attributed to complications of cirrhosis. Liver conditions have wide-ranging serological findings and imaging appearances and may require biopsy for a definitive diagnosis. Despite ultrasound (US) guidance, liver biopsy is an invasive procedure and the expected benefit must outweigh risks involved. Objective The purpose of the audit was to calculate complication rates of US-guided liver biopsy and summarize institutional data pertaining to the procedure. Materials and MethodsThe audit was performed at Aga Khan University Hospital, Karachi, Pakistan. All consecutive patients undergoing liver biopsy from February 2017 - February 2018 were included. Medical records of patients were reviewed for complications of liver biopsy. ResultsThe study population consisted of 157 adult and 21 pediatric patients. Complications were encountered in nine patients (5%), minor complications in seven (4%) and major complications in two (1.1%). Among the minor complications, haematoma formation was noted in four patients (2.2%), minor abdominal pain in two patients (1.1%), and minor hemorrhage during the procedure in one patient (0.5%). Minor complications were seen more frequently in pediatric (14%) patients as compared to adults (3.8%). One patient developed a major hemorrhage (> 2 g/dl drop in hemoglobin (Hb)), and another patient developed severe vasovagal hypotension. There was no mortality in the study population resulting from complications of the liver biopsy. The audit standards set were met for all parameters, except major hemorrhage (< 0.5%) which was narrowly missed (0.56%).ConclusionUS-guided liver biopsy at our institution has a good safety profile with complication rates within the expected range. Departmental practices are compliant with established practices and guidelines.

Treatment of steroid-resistant acute rejection after living donor liver transplantation

Introduction: Liver transplantation (LT) is the definitive treatment for the end-stage liver disease. Acute rejection used to be a common complication up to 70% of recipients within the first year. Steroid pulse therapy is useful treatment for this complication but is not a preferred treatment for steroid-resistant acute rejection (SRAR). We report the successful treatment of patient diagnosed with steroid-resistant acute rejection. Method: The patient, a 42-year-old male, who diagnosed chronic hepatitis b related liver cirrhosis, underwent living donor liver transplantation in 28th December 2015. This patient was given 20mg basiliximab as induction therapy on days 0 and 4 post-transplantation. The maintenance immunosuppressive regimens for this patient included a double regimen (tacrolimus and steroid). At 20 months after transplantation, he was admitted to our hospital presenting with the elevated serum levels of the liver enzymes and total bilirubin. We performed liver biopsy, after vascular or biliary complications were excluded by computed tomography. A liver biopsy showed acute cellular rejection. Steroid pulse therapy was not effective. Result: We was suspicious of steroid-resistant acute rejection, so liver biopsy was repeated to obtain exact diagnosis. Second liver biopsy also confirmed acute cellular rejection. He received 1.5mg/kg/day antithymocyte globulin for 5 days. He received antihistamine and antipyretic before antithymocyte globulin infusion to reduce or prevent adverse effects of antithymocyste globulin. Patient was stopped tacrolimus and 5mg/kg/day ganciclovir, ceftazidime prophylaxis was given during antithymocyte globulin therapy. After antithymocyte globulin treatment, His liver enzymes and total bilirubin were decreased. He was discharge 34 days later, and almost normalized his liver enzymes and total bilirubin. Conclusion: We have shown that antithymocyte globulin is safe and effective for treatment of steroid-resistant acute rejection, preventing from graft loss of chronic rejection.

Basic skill in liver biopsy

Liver biopsy is the best standard investigation for diagnosis of liver diseases. This procedure is not preferred by most doctors because of its serious complication such as fatal internal bleeding. Thesecomplications are indeed less than expected. The bleeding and other complications of liver biopsy can be handled by good pre-and post-operative procedures and self-care instructions. Those are:properly inform the patients about the procedure detail, arrange proper pre-procedure preparations, understand the anatomy of intercostal nerves and vascular bundles, prepare to pose the patientposition and breathe training for performing during procedure, give intravenous analgesic and anxiolytic drugs before operative procedure to calm the patient, give the local anesthesia according to instruction procedure, perform the liver biopsy strictly according to the biopsy instructions, handle the post biopsy period closely and carefully, and give the self-care instructions at home. All of these procedures and instruction have been proved to be valid and useful to prevent all complications.&#x0D; Figure 1 Axillary line&#x0D;

Escherichia coli Bacteremia Following Liver Biopsy: A Case Report of Hemobilia Related Cholangitis From Transjugular Liver Biopsy

Purpose: To present an orthotropic liver transplant (OLT) patient who had transjugular liver biopsy and developed sepsis secondary to cholangitis and bacteremia in the setting of hemobilia. Case: The patient was a 61 yo M with a history of OLT with Roux-en-Y hepaticojejeunostomy (HJ) in 2008 for cryptogenic cirrhosis. The patient did well for ten years but was referred for liver biopsy to assess for graft rejection. The biopsy was performed in a transjugular approach without immediate complication. Two days post biopsy, he developed rigors, nausea with vomiting, right upper quadrant abdominal pain, leukocytosis, and fever. Blood cultures grew E. coli. Liver ultrasound demonstrated mild left lobe intrahepatic bile ductal dilatation. MRCP was consistent with hemobilia (Image 1, Image 2). Bilirubin increased post biopsy from 1.5mg/dl on admission to 10mg/dl. A percutaneous biliary drain was placed and culture of the drain fluid grew extended-Spectrum Beta-Lactamase (ESBL) E. coli. The patient was treated with meropenem with resolution of infection and hyperbilirubinemia. The patient never developed melena and the hemoglobin remained stable. Discussion: Hemobilia is a rare complication of liver biopsy whether it is performed with a percutaneous or transjugular approach. Hemobilia can cause biliary infection due to retention of “clotted blood” within the common bile duct, particularly if there is underlying pathology which impairs drainage. In a patient with Roux-en-Y (HJ), there is a lack of a native ampulla which usually serves as a competent valve. This altered anatomy could predispose to reflux of bowel contents into the biliary tree, allowing bacteria to colonize, particularly if there is underlying biliary dilation or stricture. While hemobilia is a rare complication of liver biopsy we believe that underlying Roux-en -y (HJ) may predispose the patient to a septic complication should it occur. Our experience suggests that in order to minimize morbidity from liver biopsy that patients with Roux-en-Y (HJ), with or without evidence of impaired biliary drainage, should be considered for pre-operative prophylactic antibiotics cover enteric flora.2246_A Figure 1. T1 cross-sectional image from abdominal MRI MRCP w/o contrast showing mild prominence of the intra and extrahepatic biliary ducts2246_B Figure 2. T1 image from abdominal MRI MRCP w/o contrast showing mild prominence of the intra and extrahepatic biliary ducts2246_C Figure 3. T2 image which demonstrates proteinaceous signal within the intra and extrahepatic bile duct to the level of the hepaticojejunostomy consistent with hemobilia

Clinical Characteristics and Complications of Pediatric Liver Biopsy: A Single Centre Experience

IntroductionPercutaneous liver biopsy (LB) is the gold standard method for evaluation and management of patients with liver disease. The purpose of this study was to characterize pediatric patients undergoing LB at British Columbia Children's Hospital, and to determine the rate and timing of complications following the procedure. Material and methodsThe medical records of all pediat-ric patients who underwent LB during a six-year retrospective study were reviewed to collect demographic and procedure-related data. Results223 LBs were performed, and 179 of these biopsies were percutaneous or transjugular. Elevated liver enzymes and cholestasis together accounted for almost 70% of the indications for LB, and the histological analysis of liver tissue yielded a specific diagnosis in 89 % of the cases. There were no deaths and no major complications related to LB. The most frequent minor complication was pain (59% of LBs) and the other complications were bleeding-related and classified as minor. The vast majority of complications (88%) were recognized within 8 h of the LB. ConclusionsLB is a valuable and safe procedure in pediatric patients with a low rate of complications. Pediatric patients can be discharged home safely should no complications occur within the first 8-12 h after the procedure.

A Confusing Complication of Liver Biopsy: First Case Report of Seeding/ Implantation of Hepatocellular Carcinoma 9 Years from the Original Liver Biopsy

The incidence of seeding/implantation of hepatocellular carcinoma (HCC) after liver biopsy or radio frequency ablation (RFA) is not well reported but estimated to be low. With the introduction of immunosuppression the risk has been increased and most of the seeding sites are chest wall and abdominal muscles. We report the first case report of HCC seeding after 9 years from the original liver biopsy. A 66 years old gentleman with cirrhosis secondary to hepatitis C virus infection and long history of alcohol abuse found to have a liver lesion during his screening by ultrasound and underwent percutaneous liver biopsy, which revealed hepatocellular carcinoma in 2006 and then the patient had a liver transplantation surgery in 2006 from cardiac death donor. The post transplantation course was uneventful and started on dual immunosuppression including Tacrolimus and Mycophenolate mofetil with acceptable levels through the whole treatment duration. All the follow up routine check ups including CT scan, liver biopsy, liver function tests and cancer screening were unremarkable and alphafetoprotein (AFP) was within acceptable level except slight increase in the AFP early 2015. His increase in AFP raised the concern for recurrence of HCC and his work up for possible recurrence or metastasis was negative including CT scan of the chest, abdomen and pelvis. Later in the 2015, the patient presented to his primary care physician complaining of right upper quadrant pain and swelling for which he underwent excisional biopsy of the skin. The skin nodule been fully resected and was 1.5 cm in diameter and its 10-15 cm from the original HCC. The pathology results of the specimen revealed that its metastatic hepatocellular carcinoma involving the subcutaneous tissue with negative margins, the immunostains were positive for Heppar1 immunestains and equivocal for glypican 3. This represents a local seeding of the original HCC 9 years after the liver biopsy location. This finding also was confirmed upon reviewing the images of the original HCC and the new metastatic HCC that showed it has same track of the liver biopsy in 2006. This case report is to increase the awareness of hepatologist and primary care physicians of the risk of skin HCC implantation and consider a routine check during the clinic visits in addition to the dermatologist skin screening visits. More research needed to investigate the rule of immunosuppression on seeding and implantation of HCC.

Life Threatening Upper GI Bleeding as a Complication of Liver Biopsy

Liver biopsy is usually a safe procedure, with the rate of serious complications being around 1 percent. While pain and transient hypotension are the minor complications, patients can develop serious hemorrhagic complications. We describe a case of life-threatening GI bleeding secondary to pseudo aneurysm and presentation suggestive of hemobilia after liver biopsy, in a female with no risk factors for bleeding. 47-year-old female with hypertension, diabetes mellitus and hyperlipidemia who presented with severe, intermittent, colicky upper abdominal pain and one episode of blood in stools 10 days after an ultrasound guided liver biopsy done for hepatic lesions seen on MRI. Physical exam revealed scleral icterus and severe tenderness in epigastrium with no rebound. Labs showed a hemoglobin of 12.2 g/dL, platelets of 164x103/uL, total bilirubin of 2.7 mg/dL with direct bilirubin of 2.3 mg/dL, ALT of 509 U/L, AST of 521 U/L, ALP of 205 U/L and normal lipase. Soon after admission, she developed hemodynamically significant GI bleeding and was transferred to the ICU and given blood transfusions. CT abdomen showed amorphous material in the stomach, duodenum and small bowel, compatible with hemorrhage. MRCP showed the previously visualized hepatic lesions. ERCP showed benign biliary papillary stenosis with no filling defect or blood in the biliary duct and colonoscopy did not reveal a source of bleeding. Tagged RBC scan also failed to reveal any site of bleeding. She had an arteriogram under interventional radiology, which revealed focal pseudoaneurysm, with hepatic artery to portal vein fistula at the low branch of the left hepatic artery and was embolized with gel foam particles and coil. She improved symptomatically over the next few days and was discharged. We believe that the patient developed traumatic pseudoaneurysm that eroded into the biliary system causing delayed intermittent hemobilia after liver biopsy. This would explain the presentation of pain, bilirubinemia along with significant upper GI bleeding. Bleeding after liver biopsy can be intraperitoneal bleed, intrahepatic or subcapsular hematomas and rarely, hemobilia. A study found the incidence of hemobilia to be 0.006 percent. Hemobilia because of pseudo aneurysm may present in a delayed fashion when the pseudo aneurysm erodes into the biliary system. It may resolve with conservative management, but ongoing bleeding will require angiographic embolization or surgery.Table 1: Laboratory Values of the PatientFigure 1

Portal Vein Thrombosis as a Complication of Liver Biopsy

Portal Vein Thrombosis as a Complication of Liver Biopsy

A Confusing Complication of Liver Biopsy: First Case Report of Seeding/implantation of Hepatocellular Carcinoma 9 Years from the Original Liver Biopsy

A Confusing Complication of Liver Biopsy: First Case Report of Seeding/implantation of Hepatocellular Carcinoma 9 Years from the Original Liver Biopsy

Liver Biopsy: The Reports of Its Demise Are Greatly Exaggerated.

Liver Biopsy: The Reports of Its Demise Are Greatly Exaggerated.

Evaluation of Percutaneous Liver Biopsy Complications in Patients with Chronic Viral Hepatitis.

Liver biopsy is still the gold standard for the determination of liver fibrosis and necroinflammatory activity. It is an invasive method and may lead to severe complications. The aim of this study was to determine the evaluation of percutaneous liver biopsy complications in patients with chronic viral hepatitis. 1165 patients, who were followed with the diagnosis of chronic viral hepatitis and who were applied percutaneous liver biopsy between January 2000 and February 2013 at the out-patient clinic of Infectious Diseases and Clinical Microbiology, were included in the study. Of 1165 patients who underwent liver biopsy, 196 (86 male, 110 female) were diagnosed with chronic hepatitis C, 969 (559 male, 410 female) were diagnosed with chronic hepatitis B. The mean age was 43.3 and 55.4% were male. 11% of the patients were diagnosed with chronic renal failure and underwent haemodialysis. Minor complication rate was about 20% (severe pain required usage of analgesic drugs in 19.8%, abdominal pain in 22.6%) whereas major complication rate was 1.15% (pneumothorax in 0.17%, heamobilia in 0.08%, hematoma in 0.9%). We did not observe severe complications such as fever, abscess, anaphylaxis, bacteraemia, organ perforations, sepsis or death. Despite being an invasive procedure, percutaneous liver biopsy can be considered a safe method because of the low rates of severe complications observed in our patients.

Complications of blind versus ultrasound-guided percutaneous liver biopsy in children

Background and study aimsLiver biopsy is a well-established procedure in the diagnosis and follow-up of liver diseases. Complications of liver biopsy are rare but potentially lethal. The aim of this study was to evaluate the complications of percutaneous liver biopsy and to compare the complications of blind and ultrasound-guided percutaneous liver biopsy in paediatric wards of Nemazee Hospital of Shiraz in the south of Iran. Patient and methodTo complete the questionnaire, registered information of liver biopsies due to different causes in paediatric patients between 2008 and 2012 was retrospectively reviewed. All children aged between 0 and 18years, who underwent liver biopsy (due to any indication), participated in this study. ResultsLiver biopsies were obtained from 210 patients. Seven of 210 cases were excluded due to unreliable data. A total of 209 liver biopsies were done in the rest of the cases (n=203). Of all cases of liver biopsies, 22 (10.5%) experienced complications after biopsy. Pain (n=7) was the most frequent complication in 22 cases of liver biopsy. Mortality rate was one (0.5%) due to rupture of subcapsular haematoma. In terms of complication (p=0.592), there was no significant difference statistically between patients with blind liver biopsy (n=16) and patients with ultrasound-guided liver biopsy (n=6). ConclusionIn terms of complications, there was no significant difference when the patients were evaluated with and without ultrasound-guided biopsy.

Non-invasive assessment of fatty liver

As the result of various harmful effects (infectious agents, metabolic diseases, unhealthy diet, obesity, toxic agents, autoimmune processes) hepatic damage may develop, which can progress towards liver steatosis, and fibrosis as well. The most common etiological factors of liver damages are hepatitis B and C infection, alcohol consumption and non-alcoholic fatty liver disease. Liver biopsy is considered as the gold standard for the diagnosis of chronic liver diseases. Due to the dangers and complications of liver biopsy, studies are focused on non-invasive markers and radiological imaging for liver steatosis, progression of fatty liver, activity of the necroinflammation and the severity of the fibrosis. Authors review the possibilities of non-invasive assessment of liver steatosis. The statistical features of the probes (positive, negative predictive values, sensitivity, specificity) are reviewed. The role of radiological imaging is also discussed. Although the non-invasive methods discussed in this article are useful to assess liver steatosis, further studies are needed to validate to follow progression of the diseases and to control therapeutic response.

Major complications due to transjugular liver biopsy: Incidence, management and outcome

The purpose of this study was to retrospectively evaluate the incidence of intraperitoneal bleeding and other major complications of transjugular liver biopsy (TJLB) and analyze their outcome and management. The clinical files of 341 consecutive patients who had TJLB were retrospectively analyzed. There were 237 men and 104 women (mean age: 51.38±12.8 years; range: 17-89 years). All patients had TJLB because standard percutaneous transhepatic biopsy was contraindicated. Patients' files were reviewed to search for major and minor procedure-related complications during or immediately after TJLB. TJLBs were technically successful in 331/341 patients (97.07%; 95%CI: 94.67-98.58%). Major complications consisted exclusively of intraperitoneal bleeding due to liver capsule perforation and were observed in 2/341 patients (0.59%; 95%CI: 0.07-2.10%). They were treated using transcatheter arterial or venous embolization with a favorable outcome. The most frequent minor complications were abdominal pain (35/341; 10.26%; 95%CI: 7.25-13.99%) and supraventricular arrhythmia (15/341; 4.40%; 95%CI: 2.48-7.15%). No cases of inadvertent injury of the carotid artery were observed. Major complications during TJLB are extremely rare and can be managed using arterial or venous embolization with a favorable outcome. Our results reinforce the general assumption that TJLB is a safe and well-tolerated technique.