Liver biopsy after liver transplantation: Reported complication and literature review

Abstract

Percutaneous liver biopsy is a routinely used procedure in the postoperative period of the liver transplantation to investigate increased liver enzymes with a complication rate between 0.9 % and 3.7 %, being the hemorrhage the most common. It is reported here the case of a 52-year-old man diagnosed with cirrhosis caused by hepatitis C and alcohol who underwent liver transplantation under the Piggy Back technique 20 months ago. He had an uneventful postoperative period and started the follow-up at the Unicamp Hospital of Clinics (HC-Unicamp). Due to an unexplained elevation in the liver enzymes despite the adjustment of the immune suppression, the choice was submitting him to an inpatient percutaneous liver biopsy in order to assess a possible cellular rejection. One day after the biopsy, he presented severe abdominal pain and a significant increase in the aminotransferases associated with a 3 point decrease in the hemoglobin. A computerized abdomen scan tomography showed a major hepatic subcapsular hematoma. There was good outcome with non-operative treatment of the hematoma which required only one unit transfusion of packed red blood cells without needing other hemotherapic transfusion. He stayed at the hospital for observation for seven days, and he was discharged in good condition, restarting the outpatient-based follow up. Percutaneous liver biopsy is an invasive but very important procedure in the assessment and follow-up of the liver transplanted patients which may influence the immunosuppressive therapy as well as to diagnose the HCV recurrence and enable to treat such cases. Nevertheless, it is not free from complications inherent to the procedure, as reported here, and its indication should always be thoroughly evaluated, as it can be observed with no surgical procedure.