title: Liver biopsy in liver transplantation: no additional risk of infections in patients with choledochojejunostomy.
abstract: OBJECTIVE
  This study aimed to determine whether there is an increased infectious risk following liver biopsy in liver transplant patients with choledochojejunostomy.
  
  
  METHODS
  We evaluated the incidence of liver-biopsy-related sepsis in a consecutive series of 27 patients who underwent choledochojejunostomy, either during the transplant procedure (17 patients) or later following biliary complications (10 patients). We evaluated another 138 patients as a control group who had orthotopic liver transplantation during the same period and underwent duct-to-duct anastomosis. All liver biopsies had routine, prior ultrasound evaluation to detect dilated biliary ducts.
  
  
  RESULTS
  In the 27 patients who underwent choledochojejunostomy, 96 liver biopsies were performed: the sepsis rate was 3.12% per biopsy (n = 96) or 7.4% per patient (n = 27). However, despite a normal ultrasound, subsequent ERCP demonstrated biliary obstruction in one patient. Thus the rate of sepsis was 2.1% per biopsy or 3.7 per patient. In the control group 338 liver biopsies were performed: the sepsis rate was 1.5% per biopsy (n = 338) or 2.9% per patient (n = 138). The difference was not significant. All septic episodes had positive blood cultures for a single enteric microorganism, and all responded to antibiotics
  
  
  CONCLUSIONS
  Our data do not suggest that liver-transplanted patients with choledochojejunostomy are more at risk of sepsis following liver biopsy, providing there is no "occult" biliary obstruction; therefore, they do not require prophylactic antibiotics as has been suggested by other authors.
authors.affiliation: Liver Transplantation Unit, Royal Free Hospital, Hampstead, London, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Ben-Ari
authors.forename: L
authors.initials: L
authors.lastname: Neville
authors.forename: K
authors.initials: K
authors.lastname: Rolles
authors.forename: B
authors.initials: B
authors.lastname: Davidson
authors.forename: A K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology*; D001442:Bacteroides Infections / Q000188:drug therapy / Q000209:etiology*; D001441:Bacteroides fragilis / Q000187:drug effects / Q000302:isolation & purification*; D001707:Biopsy, Needle / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002768:Choledochostomy; D004754:Enterobacter / Q000187:drug effects / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000209:etiology*; D013293:Enterococcus faecalis / Q000187:drug effects / Q000302:isolation & purification*; D005260:Female; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008099:Liver / Q000382:microbiology / Q000473:pathology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents