Data from published studies regarding risk factors for liver biopsy (LB)-related infectious complications in liver transplant recipients are inconsistent. We carried out a retrospective cohort study analyzing consecutive LBs for orthotopic liver transplant patients at a tertiary hospital (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011): there were 667 LB procedures (575 percutaneous procedures and 92 transjugular procedures) in 286 liver transplant recipients. There were 20 complications in 19 patients (overall incidence 5 3.0%): 10 were infectious complications (8 cases of bacteremia and 2 cases of peritonitis). The causal microorganisms were mainly Pseudomonas aeruginosa (4 patients) and Enterobacteriaceae (4 patients). All complications occurred with biopsies performed in patients hospitalized for more than 48 hours (381 biopsies for 201 patients); hence, only this group was included in the risk factor analysis. The variables associated with the development of infectious complications after LB were the presence of impaired biliary drainage at the time of biopsy (40% versus 15.1%, P 5 0.03) and low albumin levels (2.4 versus 3.1 g/dL, P 5 0.01). In conclusion, according to our experience, infectious complications secondary to LB in liver transplant recipients are related to hospitalization at the time of biopsy, particularly in the presence of impaired biliary drainage and low albumin levels. Liver Transpl 20:552-556, 2014. V C 2014 AASLD.Received October 6, 2013; accepted December 22, 2013.The incidence of infectious complications associated with liver biopsy (LB) is low, with reported rates of 0% to 3.15% of percutaneous biopsy procedures. 1 Transient bacteremia, cholangitis, and liver abscesses have been described. 2 Some studies have documented a higher incidence of biopsy-related infections in patients with a bile duct obstruction or a Roux-en-Y loop biliary bypass in comparison with patients with a choledochocholedochostomy (CDC), 3,4 but this finding has not been supported by other authors. Thus, the published results to date are inconsistent with respect to the existence of a high-risk population within this group of patients. Furthermore, very few available studies have addressed complications related to an increasingly more widely used technique, transjugular liver biopsy (TJLB), in addition to complications related to percutaneous liver biopsy (PLB). Thus, there is currently insufficient scientific evidence to support or rule out the use of antibiotic prophylaxis in this setting to prevent septic complications. The aims of this study were to identify risk factors for the development of infectious complications related to LB in recipients of orthotopic liver transplantation (OLT) over the course of the last 10 years and to investigate the incidence of this event with both TJLB and PLB procedures.

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The second part of the Latin American recommendations for the management of Arterial Hypertension (HTA) in adults is presented. In a first phase, the most relevant aspects of epidemiology, physiopathological aspects, how to diagnose, therapeutic guidelines, hypertension emergencies, special populations, refractory hypertension and the application of guides in real life have been described. In this second part, recommendations are issued answering specific questions for primary, secondary, tertiary and quaternary prevention. In general, few recommendations regarding the management of arterial hypertension arise from the medical clinic / internal medicine, despite two situations: the majority of patients with hypertension are evaluated and managed by the clinicians, and the medical clinic is the specialty that allows the holistic and integrated look of the health problems in adults, allowing to add the biographical approach to the biological, to understand and interpret not only the health problem but its causes and consequences (which often correspond to different parenchyma, which in the fragmented model would make the patient move through different specialties). The low percentage of controlled hypertensive patients forces all the professionals involved in the management of them to optimize resources and detect problems that are associated with a deficit control such as the under utilization of pharmacological treatment, low rate of patients treated with combined strategy (the most patients currently receive monotherapy), lack of adequate prescription of changes in lifestyle, low therapeutic adherence and clinical inertia. This publication presents recommendations made by specialists in medical clinic/internal medicine for the management of hypertension in adults, answering primary, secondary, tertiary and quaternary prevention questions.

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