The role for liver biopsy in haemophiliacs infected with the hepatitis C virus

Prior to the introduction of virally inactivated clotting factor concentrates, the majority of individuals with congenital bleeding disorders became infected with the hepatitis C virus. Although liver biopsy is valuable in prognosis and guiding antiviral therapy, there is a reluctance to perform biopsies in this population because of the risk of hemorrhage. The purpose of this study was to evaluate the safety of transjugular liver biopsy, and the usefulness of evaluating liver histology in this patient population. Liver histopathology was assessed by the METAVIR index and compared with corrected sinusoidal pressures, platelet counts, and abdominal ultrasonography. Liver biopsy was performed at seven Canadian centers in 65 patients with hemophilia or von Willebrand's disease. Biopsies were done on an outpatient basis, followed by a 4‐hr observation period in hospital. Normal hemostasis was maintained during the peribiopsy period, with follow‐up doses of factor concentrate self administered by the patient at home. One patient (1.4%) had significant bleeding leading to readmission and red cell transfusion. Liver histology showed 14 patients (22%) had cirrhosis. Ten patients had elevated corrected sinusoidal pressures; 7 of these (70%) had cirrhosis on biopsy, and the other 3 (30%) likely had cirrhosis although histology showed stage 3 fibrosis. This series represents the largest reported experience of transjugular biopsy in individuals with congenital bleeding disorders. We conclude that this procedure can be safely performed on an outpatient basis. The diagnosis of cirrhosis and/or portal hypertension was made in a substantial proportion of individuals (26%), all of whom had asymptomatic liver disease. Am. J. Hematol. 78:85–93, 2005. © 2005 Wiley‐Liss, Inc.

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The role of liver biopsy in chronic hepatitis C

Dienstag

2002

Hepatology

246

129

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The report of the 1997 National Institutes of Health Consensus Development Conference on hepatitis C endorsed pretreatment liver biopsy. We revisit the following questions: Does liver histology help determine the urgency of, and predict the likelihood of response to, antiviral therapy, and can surrogate markers supplant histological assessment? Because the rate of progression of chronic hepatitis C is influenced by baseline histological grade/stage, patients can be stratified into those with moderate to severe hepatitis, who merit imminent therapy, and those with mild hepatitis, in whom therapy can be postponed until more effectiveholerable treatments become available. Less advanced baseline histology has been shown to be an independent predictor of responsiveness to antiviral therapy. Although the predictive value of biopsy is insufficient to withhold therapy from patients with advanced fibrosis, baseline biopsy helps gauge expectations for the outcome of therapy. Reports have been published recently suggesting that laboratory markers can predict distinctions between low-grade fibrosis and therapy-indicating septal fibrosis/cirrhosis. These indices, however, are insufficiently reliable to predict histological distinctions in populations with varying prevalences of fibrosis/cirrhosis or to provide anything more than broad qualitative distinctions, far short of the potential information in a liver biopsy. For most patients, the value of pretreatment liver biopsy outweighs its risks, provides information about the urgency of treatment, and should be retained. Studies to identify noninvasive laboratory markers of histological activity and stage, especially genetic predictors of accelerated disease progression, command a high priority. (HEPATOLOGY 2002;36:S152-S160.) s the efficacy of therapy for chronic hepatitis C improves, as acceptance of such therapy becomes A more widespread, and as management of chronic hepatitis C extends from specialist hepatologists to nonspecialists, the role of liver biopsy in the management of chronic hepatitis C is being re-examined. When the role of liver biopsy was considered during the previous NaAbbreviations: HAL histology activity index; HCK hepatitis C virus; AL T, alanine aminotransferax; AST, aspartate aminotransferase.

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The role for liver biopsy in haemophiliacs infected with the hepatitis C virus

Cited by 31 publications

References 21 publications

Transfusion Transmitted Disease: Hepatitis C Virus Infection and Liver Transplantation

Transfusion Transmitted Disease: Hepatitis C Virus Infection and Liver Transplantation

A Canadian multicenter retrospective study evaluating transjugular liver biopsy in patients with congenital bleeding disorders and hepatitis C: Is it safe and useful?

The role of liver biopsy in chronic hepatitis C

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