"Assessment of Safety and Efficacy of Transjugular Liver Biopsy As a Diagnostic Method in Adult Patients with Congenital Bleeding Disorders with HCV Infection "

Background/Objectives: Liver biopsy in patients with congenital bleeding disorders (CBD) and hepatitis C virus (HCV) infection is still a challenge between risk of procedure and effect of biopsy result on management. Materials and Methods: We did transjugular liver biopsy (TJLB) on 12 patients with CBD with chronic HCV infection and elevated liver enzymes to determine its safety, efficiency and therapeutic conse-quences. Results: All patients were men, with a median age of 29.5 years (14–54 years). Eleven patients had haemophilia A (10 severe, one moder-ate) and one patient had factor XIII deficiency, with no titer of inhibitor. HCV genotyping was carried out with type 1a (7 patients), type 1b (2 patients), type 3 (2 patients) and genotype 1a and 1b (1 patient). HIV and HBV co-infection was negative in all patients. We used the modified Ross needle with 100% transjugular access rate to the hepatic veins and 92% success rate in tissue obtaining. The specimen obtained was satisfactory but limited for histopathologic diagnosis in 54.5%. Mild hepatitis was revealed in 4 patients (36.4%), moderate hepatitis in 5 (45.4%) and extended fibrosis or cirrhosis in 2 (18.2%). There were 2 procedure-related complications (16.6%). The major limitation of technique was low number of portal area in liver biopsies. Conclusion: TJLB with some limitations is useful in patients with CBD. Transjugular approach to liver biopsy is a safe and effective alternative to the percutaneous approach in patients with CBD and could be requested to determine their liver prognosis and considered for diagnostic liver biopsy prior to anti-HCV therapy.