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

Abstract

The prevalence of chronic hepatitis C virus (HCV) infection among patients with severe congenital bleeding disorders is as high as 98%. Advances in HCV treatment currently result in sustained virological response rates of > or =50%. Recent recommendations have reaffirmed that liver biopsy, which provides a direct histological assessment of liver inflammation and fibrosis, is still important for accurate diagnosis and therapeutic decision making. Percutaneous liver biopsy is a simple, standardized procedure that can be performed rapidly and relatively inexpensively, and has been safely performed in patients with congenital coagulopathies. However, the safety and efficacy of the transjugular approach (transjugular liver biopsy, TJLB), recommended for patients with acquired coagulopathies, has only been minimally studied in the congenital bleeding diathesis population. We now report our institutional experience with TJLB in 13 such adult patients (mean age 33 years) with severe/mild haemophilia A/B (10); von Willebrand disease (1); factor V deficiency (1) and factor XIII deficiency (1). Data were collected by retrospective chart review and the TJLB was performed according to institutional protocol as described. Haemostasis prophylaxis was given for 1-5 days. Patients were hospitalized for < or =48 h and all tolerated the procedure without bleeding. Three patients experienced self-limited abdominal discomfort; one episode was accompanied by transient transaminaemia. Diagnostic specimens were obtained from all patients and were instrumental in the therapeutic decision-making process. We suggest that with a co-ordinated multidisciplinary approach to care, TJLB is a safe, effective and potentially cost-effective alternative to the percutaneous approach in the congenital bleeding disorders population.

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.…”

Transjugular liver biopsy – Indications, adequacy, quality of specimens, and complications – A systematic review

“…Only three studies compared length separately in cirrhotic and non-cirrhotic specimens showing no difference using Tru-cut needle in 2, [23,59] and longer specimens in non-cirrhotics using either Menghini or Tru-Cut needle in 1. [67] Only two small series with non-cirrhotic patients [18,37] gave both mean length and mean CPT number: 23 mm with nine CPTs (Menghini); 13.6 mm with six CPTs (Tru-Cut). The mean number of passes was not significantly associated with the mean length (r = 0.34, p = 0.1).…”

“…TJLB is usually indicated when PLB is contraindicated due to coagulopathy and/or ascites [2,6], in liver transplant recipients [7][8][9][10][11], and patients with acute liver failure (ALF) [12,13] or congenital clotting disorders [14][15][16][17][18].…”

Asian Variant of Intravascular Lymphoma: Aspects of Diagnosis and the Role of Rituximab

“…Furthermore, we diagnosed two patients by performing TJLB. DiMichele et al reported that TJLB is an alternative to the percutaneous approach for patients with bleeding disorders (16 (21). Although rituximab has not been widely utilized for IVL, some studies have found it to be effective (5,(22)(23)(24)(25)(26)(27)(28)(29) …”