Safety and potential usefulness of liver biopsy in HIV‐seropositive haemophiliacs employing a transjugular venous approach

Abstract

Chronic liver disease has affected a majority of haemophiliacs exposed to factor VIII and factor IX concentrates before effective viral attenuation techniques were introduced. Progressive hepatitis and liver failure have increasingly become causes of morbidity, especially in haemophilia patients also seropositive for HIV. Encouraging reports of recombinant alpha interferon to reverse the histological, laboratory and clinical deterioration of chronic active hepatitis justifies obtaining liver biopsies to assess the severity of liver damage; however, the percutaneous method carries a significant risk of bleeding. Therefore, we employed a transjugular venous approach for liver biopsies in six HCV-, HBSAb- and HIV-seropositive adults with severe haemophilia A (n = 5) or B (n = 1) with persistent liver function abnormalities. Adequacy of the specimens and lack of haemorrhagic complications leads us to conclude that this procedure appears to be safe and effective in individuals with severe haemophilia or other congenital or acquired coagulopathies.

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

“…Only two smaller studies (with sample sizes of 6 and 13) have examined the safety of the transjugular approach in patients with congenital bleeding disorders [21,22]. Gupta et al [22] used more aggressive hemostasis prophylaxis, but Dimichele et al [21] used prophylaxis regimens similar to our own. There were no significant bleeding complications noted in either Gupta's or Dimichele's cohorts.…”

Interest of transjugular liver biopsy in adult patients with haemophilia or other congenital bleeding disorders infected with hepatitis C virus

“…Logically, TJLB associated with adequate factor replacement has been proposed for patients with CBD infected with HCV (Makris et al , 2001). However, only a few series of patients with CBD have been reported with this technique to date (Gupta et al , 1997; DiMichele et al , 2003). Gupta et al (1997) reported the results of TJLB in a cohort of six HIV‐positive but HCV‐negative patients with CBD.…”

“…However, only a few series of patients with CBD have been reported with this technique to date (Gupta et al , 1997; DiMichele et al , 2003). Gupta et al (1997) reported the results of TJLB in a cohort of six HIV‐positive but HCV‐negative patients with CBD. DiMichele et al (2003) reported their experience of 13 TJLB in adult CBD patients with HCV infection without significant morbidity.…”

Transjugular liver biopsy is safe and diagnostic for patients with congenital bleeding disorders and hepatitis C infection

“…Our cohort experienced no procedure‐associated haemorrhage with the use of a less‐stringent haemostasis prophylaxis and a shorter hospitalization period than that previously described for haemophilia patients by Gupta et al . [15]. However, neither the factor replacement requirement nor period of hospitalization was necessarily shortened in comparison to similar reported cohorts of patients who underwent percutaneous liver biopsy [12–14].…”