title: Fibrin-glue sealed liver biopsy in patients with a liver transplantation or in liver transplantation waiting list: preliminary results.
abstract: Liver biopsy is frequently necessary for candidate evaluation or histologic follow-up of transplanted livers. Although generally considered to be safe, it carries a risk of complications in up to 0.5% of cases; hemorrhage being the most important. It can present as an asymptomatic intra- or perihepatic hematoma or result in overt hemorrhage of variable intensity. Patients with deranged hemostasis or on antiaggregant therapy are at high-risk for hemorrhagic complications. Percutaneous liver biopsy may be contraindicated if hemostasis is profoundly disordered. Safety values are not well defined: arbitrary limits are 60% prothrombin activity and 60,000 platelets per mm3. Patients with more altered values are candidates for alternative techniques, such as transjugular biopsy. Another option is the so-called plugged percutaneous liver biopsy, which uses direct injection of a plugging material into the biopsy tract. Different materials have been used: Tissucol, absorbable gelatin sponge, or hemostasis coils. We communicate our experience with Tissucol (fibrin glue) plugging in 30 percutaneous liver biopsies on 16 patients after liver transplantation with prothrombin activity <60%, platelet count <60,000 per mm3, or both. Only two complications were observed. Plugged liver biopsy is an efficient and relatively safe procedure in patients with impaired hemostasis; it can be performed even when transjugular biopsy is not available.
authors.affiliation: Department of Gastroenterology, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Albéniz Arbizu
authors.forename: A
authors.initials: A
authors.lastname: López San Román
authors.forename: M
authors.initials: M
authors.lastname: Garcia González
authors.forename: J R
authors.initials: JR
authors.lastname: Foruny Olcina
authors.forename: F
authors.initials: F
authors.lastname: Garcia-Hoz Rosales
authors.forename: R
authors.initials: R
authors.lastname: Bárcena Marugán
authors.forename: G
authors.initials: G
authors.lastname: Plaza Palacios
authors.forename: L A
authors.initials: LA
authors.lastname: Gil Grande
mesh_terms: D001706:Biopsy / Q000379:methods*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006487:Hemostasis; D006801:Humans; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation; D018579:Patient Selection; D011517:Prothrombin Time; D012449:Safety; D014014:Tissue Adhesives; D014850:Waiting Lists
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives