There is controversy about the frequency of and risk factors rate of 0.2% to 1.8%. 1,2,3,4,5 Most complications are caused for infectious complications of percutaneous liver biopsy in by either lung perforation or bleeding from lacerated interliver transplant recipients. The aim of this study was to idencostal or intrahepatic blood vessels. Bacteremia, cholangitis, tify the incidence and nature of complications associated with and hepatic abscess have been reported following liver biopsy liver biopsy after orthotopic liver transplantation (OLT), with in patients with extrahepatic biliary obstruction. 6,7,8 There is particular emphasis on infection. The medical records of all little published literature on complications associated with patients undergoing OLT between January 1990 and August PLBx in liver transplant recipients. Some studies have sug-1994 were reviewed retrospectively to identify complications gested that orthotopic liver transplant (OLT) recipients with requiring hospitalization within one week of percutaneous a choledochojejunostomy (CDJ) may have increased risk of liver biopsy. The nature and severity of complications were infectious complications after PLBx compared with those recorded and possible risk factors for infectious complications with a choledochocholedochostomy (CDC). 9 This finding were examined. One hundred ninety-eight patients underwent has not, however, been confirmed by others. 10,11 The purpose 1,136 percutaneous liver biopsies. There were eleven compliof this study was twofold, as follows: 1) to evaluate the overall cations (0.96%), including as follows: 7 infections, 3 bleeding safety of outpatient percutaneous liver biopsy in liver transepisodes, and 1 vasovagal reaction. Infections after percutaneplant recipients; and 2) to assess the incidence of infectious ous liver biopsy included fever and bacteremia (n Γ
6), and complications and determine whether the presence of a fever without bacteremia (n Γ
1). All infections developed Roux-en-Y (CDJ) increases the risk of infection. only in patients with underlying biliary tract abnormalities; the frequency of infection was higher (9.8%) in patients with
MATERIALS AND METHODS choledochojejunostomy when compared with those with
Percutaneous liver biopsies performed on all liver transplant recholedochocholedochostomy (1.4%). Bacteremia was more cipients at the University of Washington Medical Center between likely caused by skin flora in patients with choledochocholeo-January 1990 and August 1994 were reviewed. The majority were
chostomy (CDC) and by enteric bacteria in patients with
protocol biopsies performed on days 10, 21, and 30, on months 3 choledochojejunostomy (CDJ). All infections were treated and 6, and yearly after transplantation. Indications for liver biopsy, successfully with parenteral antibiotics. We conclude that biliother than protocol, included liver enzyme abnormalities or to eval- ary tract abnormalities are the primary risk factors for infecuate response to changes in immunosuppression. PLBx was per- tion after percutaneous liver biopsy, although the risk is formed as an outpatient procedure, and patients were usually dis- higher in patients with CDJ than with CDC. These data supcharged after a 6-hour observation period. The transplant records port the use of antibiotic prophylaxis before percutaneous of all liver transplant recipients undergoing liver biopsy were re- liver biopsy in OLT recipients with biliary tract abnormalities. viewed to identify those admitted to the hospital during the week (HEPATOLOGY 1997;26:1406-1409.) following biopsy. The hospital charts of these patients were then reviewed to determine whether the admission was related to a biopsy complication.
Liver biopsy is frequently performed in liver transplant Biopsy Method. Liver biopsy was performed only if the platelet recipients. The percutaneous approach is the most frequently count was ΓΊ70,000/mL and if the prothrombin time was not more used technique. Numerous studies have shown that outpathan 3 seconds prolonged when compared with control values. tient percutaneous liver biopsy (PLBx) in non-liver-trans-Fresh frozen plasma and/or platelet concentrates were used to cor- plant patients has an overall procedure-related complication rect thrombocytopenia or prolonged prothrombin time in patients requiring biopsy. Biopsies were performed using the Menghini aspiration method 12 using a 16-gauge Klatskin needle. Hepatic parenchymal ultrasound with duplex color doppler assessment of the Abbreviations: OLT, orthotopic liver transplantation; PLBx, percutaneous liver bihepatic vasculature was performed on each patient prior to biopsy. opsy; CDJ, choledochojejunostomy; CDC, choledochocholedochostomy.