Evaluation of Transjugular Liver Biopsy in the Diagnosis of Early Hepatic Dysfunction After Allogeneic Hematopoietic Cell Transplantation

Introduction: Liver biopsy might be necessary in the diagnosis of liver dysfunction after allogeneic stem cell transplantation (allo-SCT) but transparietal (TP) access is usually not possible. Transjugular liver biopsies (TJLB) may offer a good alternative. We retrospectively analyzed the role of TJLB in the diagnosis of early hepatic dysfunction after allo-SCT.

Methods: We included all consecutive allo-SCT recipients undergoing TJLB in our centre from May 1997 to September 2011. Median follow-up for survivors was 28 months (1-57). According to our protocol, TJLB instead of TP access was preferred in patients with platelet count <50x10e9/L, coagulation abnormalities or unstable medical condition. TJLB were performed using a needle coated with a flexible catheter through jugular access. Pathological samples were analyzed by an experienced pathologist in the centre and retrospectively revised.

Results: In the study period 153 allo-SCT transplants were performed in our center. A total of 22 patients (14%) underwent 24 TJLB procedures at a median of 38 days (12-152) after transplant. Median age was 29 years (range 17-64). Most patients received myeloablative allo-SCT (n=18) mainly for AML (n=6). Transjugular route was chosen because of thrombocytopenia (n=12, 50%), coagulation abnormalities (n=2, 8.3%) or both (n=10, 41%). Clinical suspicions before TJLB were hepatic sinusoidal obstructive syndrome (SOS) (n=12, 50%) and GVHD (n=12, 50%). The biopsy allowed a diagnosis in 17 cases (70%) including: iron overload/cholestatic liver disease (n=8),  liver GVHD (n=4), HSOS (n=3),  and one case each of cholangitis lenta and CMV hepatitis (n=2). Main clinical suspicion was confirmed after biopsy in 5 (21%) cases while in 12 (50%) it revealed another initial diagnosis suspected and supposed a change of therapeutic approach in 8 (33%) of them. Seven (29%) biopsies were non-diagnostic, 5 due to unspecific findings and 2 because of insufficient sample size. Although commonly TJLB-related complications were mild, mainly subcutaneous hematoma (n=3, 12.5%) there also was one TJLB-related death because of severe bleeding. In summary, TJLB allowed for the identification of a cause of liver abnormality in 70% of our patients, including 33% in which the diagnosis implied a change in the therapy. It may be a helpful tool in the diagnosis of liver abnormalities, with moderate toxicity but not risk-free.