Ultrasonographically guided percutaneous transhepatic liver biopsy after pediatric liver transplantation

Abstract

Background: Complications associated with ultrasonographically guided percutaneous transhepatic liver biopsy (PTLB) after liver transplantation (LT) have been rarely reported, and there is no consensus about its safety. We retrospectively reviewed the safety and outcomes of PTLB after pediatric LT. Methods: Between January 2008 and December 2019, 8/1122 (0.71%) pediatric patients who underwent ultrasonographically guided PTLB after LT developed complications. The median age at PTLB was 7.8 years (range 0.1-17.9). Grafts included left lobe/left lateral segment in 1050 patients and others in 72. PTLB was performed using local anesthesia±sedation in 1028 patients and general anesthesia in 94. Results: Complications after PTLB included acute cholangitis in 3 patients, sepsis in 2, respiratory failure due to over-sedation in 1, subcapsular hematoma in 1, and intrahepatic arterioportal fistula in 1. The incidence of complications of PTLB in patients with biopsy alone and those with simultaneous interventions was 0.49% and 3.19%, respectively (p = .023). Patients who developed acute cholangitis, respiratory failure, subcapsular hematoma, and arterioportal fistula improved with non-operative management. Of two patients with sepsis, one underwent PTLB and percutaneous transhepatic portal vein balloon dilatation and developed fever and seizures the following day. Sepsis was treated with antibiotic therapy. Another patient who underwent PTLB and exchange of percutaneous transhepatic biliary drainage catheter developed fever and impaired consciousness immediately. Sepsis was treated with antibiotic therapy, mechanical ventilation, and continuous hemofiltration.Conclusions: Percutaneous transhepatic liver biopsy after pediatric LT is safe.However, combining liver biopsy with simultaneous procedures for vascular and biliary complications is associated with an increased risk of complications.

The influence of neighborhood income on healthcare utilization in pediatric liver transplant

“…Liver biopsies come at a cost to patients, including the risks associated with an invasive procedure, financial costs, and missed days from school or work. [17][18][19][20] Moreover, while a relatively safe procedure, liver biopsies are resource intensive procedures-they usually require anesthesia, proceduralist involvement, and an overnight stay. 19,20 Thus, addressing this disparity may improve both caregiver experience of hassle and hospital churn and capacity.…”

“…[17][18][19][20] Moreover, while a relatively safe procedure, liver biopsies are resource intensive procedures-they usually require anesthesia, proceduralist involvement, and an overnight stay. 19,20 Thus, addressing this disparity may improve both caregiver experience of hassle and hospital churn and capacity. It is possible that the observed increase in liver biopsies among those from lower-income neighborhoods reflects poorer allograft health, provider bias, or heightened concern for poor adherence.…”

Major complications after percutaneous biopsy of native or transplanted liver in pediatric patients: a nationwide inpatient database study in Japan

“…Although the reasons for lower complication rates in cases with transplanted liver may be uncertain, relatively preserved liver function or the absence of liver cancer in the transplanted liver may contribute to the lower rate of major complications. Additionally, PLB is usually performed with a substernal approach in pediatric patients with transplanted liver [ 11 , 12 , 22 ], and compression hemostasis following PLB may be easier.…”

Role of Liver Biopsy in Evaluation of Fibrosis: Review Article

“…Patients with suspected but unconfirmed liver illness or those with abnormal liver tests of unclear cause fall under this category. Patients with genetic illnesses such Wilson disease, alpha-1 antitrypsin deficiency, glycogen storage diseases, and others are used as examples (4) .…”

“…Patients who appear to have systemic disorders in which the liver plays a role may also benefit from liver histology for diagnostic purposes. Patients suspected of having hereditary hemorrhagic telangiectasia should have their livers examined microscopically only if absolutely required, and this should be done transvenously in tandem with a measurement of the portosystemic pressure gradient (4) .…”