**4. Post-transplant liver enzyme abnormalities**

Percutaneous liver biopsy can be performed rapidly and safely in an outpatient setting with the appropriate monitoring equipment and staff availability [5]. After discharge, patients are typically instructed to avoid strenuous physical activity or driving for 24-48 hours, and are asked to contact the clinical provider in the event of concerning symptoms. In our institu‐ tion, a review of over 3,000 liver biopsies (including liver transplant patients) demonstrated that the majority of complications were discovered within the first hour after percutaneous liver biopsy, and that shortening the recovery time to 1-2 hours did not impact the frequen‐

Percutaneous liver biopsy can be performed with suction needles (such as Jamshidi needle or Menghini needle), cutting needles (such as the Tru-Cut needle), or spring-loaded needle "guns". Specimens adequate for diagnosis, grading, and staging can usually be obtained by

In patients with severe/uncorrectable coagulopathy, thrombocytopenia (typically platelet

lar liver biopsy (TJLB) is typically recommended [7]. In addition, TJLB is useful in patients for whom wedged hepatic venous pressure gradient (HVPG) measurement would be clini‐ cally useful. Miraglia et al reported on the safety of TJLB in liver transplant patients, with

TJLB is typically performed with the use of automated needle systems, such as the Quick-Core needle and the Flexcore needle. It has been established that these automated needle systems often require multiple passes, and usually collect smaller core samples than those obtained by percutaneous liver biopsy [9]. Despite this fact, specimens ob‐ tained via TJLB are adequate for diagnosis, staging, and grading liver disease in greater

Surgical liver biopsies (either open liver biopsy or laparoscopic liver biopsy) are typically performed when patients require a surgical procedure for another indication. In liver trans‐ plant patients, this often involves repair of postoperative hernias. Biopsies in this setting can be performed with either automated needle systems or with a wedge resection, and the pro‐ cedure provides the advantage of direct visualization of the liver and the ability to immedi‐

Although invasive, liver biopsy is a relative safe procedure, whether performed percutane‐ ously or via the transvenous route. In a review of over 60,000 non-transplant patients, death within seven days directly related to liver biopsy occurred in 1 out of every 10,000 proce‐ dures, and all-cause mortality within seven days occurred in approximately 0.2% of patients [12]. Serious complications were similarly rare, with pain occurring in 2% of patients, hemo‐ peritoneum occurring in 0.04%, and hemobilia occurring in 0.01% [12]. Similarly, studies of allograft liver biopsies demonstrate a mortality rate of up to 0.2%, and a rate of major com‐

), large ascites, morbid obesity, or an inability to cooperate, a transjugu‐

cy of complications [6].

190 Liver Biopsy - Indications, Procedures, Results

count < 50,000/mm3

than 90% of cases [10,11].

all of the biopsy needles used in current practice.

only one complication in 183 biopsies (0.5%) [8].

ately diagnose and treat any bleeding which occurs.

**3. Complications of liver biopsy**

Abnormalities in liver enzyme levels are often encountered in liver transplant patients, and can represent hepatocellular injury (reflected by the transaminases), biliary injury [reflected by alkaline phosphatase or gamma-glutamyl transferase (GGT)], or hepatic synthetic dys‐ function (reflected by the albumin or by coagulation abnormalities). While the use of serum blood tests (such as viral or autoimmune serologies) and imaging techniques (such as ultra‐ sound with Doppler, angiography, and magnetic resonance cholangiography) can be useful to determine the etiology of abnormal liver enzymes, liver biopsy is often necessary for a definitive diagnosis.
