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

Abstract

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.

AASLD position paper: Liver biopsy

“…However, critical review of the existing literature suggests that the risk of bleeding (presumably due to capsular hemorrhage) appears to be approximately similar to that associated with standard percutaneous biopsy, 35,105,114,159,180 perhaps related to the risk of capsular piercing with subsequent hemorrhage. In a recent systematic review, minor and major complications were reported in 6.5% and 0.6%, respectively, of 7649 patients after transvenous biopsy.…”

“…These include patients with factor VIII (FVIII) or IX (FIX) deficiency, von Willebrand's disease and other hereditary bleeding disorders, [156][157][158][159] and those with sickle cell anemia. 160 Patients with known underlying coagulopathy requiring liver biopsy represent a challenge, but it should be emphasized that liver biopsy (percutaneous or transvenous) can be performed in these patients (with definitive factor replacement).…”

Role of transjugular liver biopsy in the diagnostic and therapeutic management of patients with severe liver disease

“…Liver biopsy is considered to be very useful in diagnosing and treating patients with abnormal liver function tests [1][2][3][4]. Transjugular biopsy allows histological samples to be acquired from patients in whom percutaneous puncture is contraindicated [5,6].…”

The Aging Patient with Hemophilia: Complications, Comorbidities, and Management Issues

“…Factor VIII or IX replacement to achieve levels 80 to 100 U/dL prior to biopsy, with continued factor replacement to maintain levels Ͼ50 U/dL for 2 to 4 d following biopsy, has been associated with a 1% to 2% rate of clinically significant bleeding. 21 Recently, transient elastography has been proposed as a noninvasive tool for the assessment of liver fibrosis in hemophilia patients. 22 Liver transplantation is an option for hemophilia patients with end-stage liver disease who are infected with HCV or HCV-/HIV and corrects the factor deficiency.…”