Laparoscopic evaluation of liver disease in chronic renal failure prior to renal transplantation.
BACKGROUND
Diagnostic laparoscopy with liver biopsy has been shown to be safe and effective in the evaluation of patients with chronic liver disease. Patients with end-stage renal disease may be more prone to bleeding complications secondary to liver biopsy as a result of multiple factors directly related to their underlying renal condition.


METHODS
From January 1994 to June 1996, 16 patients with end-stage renal disease and hepatic dysfunction (6 women and 10 men) underwent diagnostic laparoscopy with liver biopsy prior to renal transplantation at the University of Miami School of Medicine. Laparoscopy was performed using a 5 mm video laparoscope with a left paramedian approach. The mean patient age was 46 years. Fourteen patients had chronic hepatitis C with a reactive anti-HCV by ELISA; one patient had chronic hepatitis B with reactive HBsAg, and one patient was co-infected with both hepatitis B and C viruses.


RESULTS
Two patients developed hypotension related to the procedure and one patient developed an intra-abdominal hemorrhage 5 days after laparoscopy that did not require surgical intervention. Biopsy findings were as follows: 13 patients had mild chronic hepatitis; 2 patients had chronic hepatitis with bridging fibrosis; and 1 patient was cirrhotic. Prior kidney transplantation or peritoneal dialysis did not preclude the performance of laparoscopy.


CONCLUSIONS
Diagnostic laparoscopy can be safety performed in patients with end-stage renal disease with acceptable morbidity and mortality.
Ribeiro
A
A
Center for Liver Diseases, University of Miami, School of Medicine, FL 33136, USA.
Reddy
R
R
Bernstein
D E
DE
Roth
D
D
Jeffers
L
L
Schiff
E R
ER
D000005:Abdomen / Q000098:blood supply; D000328:Adult; D000368:Aged; D001706:Biopsy; D002908:Chronic Disease; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D016174:Hepacivirus / Q000276:immunology; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000276:immunology; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D018937:Hepatitis C Antibodies / Q000276:immunology; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008107:Liver Diseases / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012449:Safety; D015996:Survival Rate; D014741:Video Recording
D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies