Liver biopsy in liver transplantation: no additional risk of infections in patients with choledochojejunostomy.
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.
Ben-Ari
Z
Z
Liver Transplantation Unit, Royal Free Hospital, Hampstead, London, UK.
Neville
L
L
Rolles
K
K
Davidson
B
B
Burroughs
A K
AK
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
D000900:Anti-Bacterial Agents