Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial.
OBJECTIVE
Although percutaneous liver biopsy is a standard diagnostic procedure, it has drawbacks, including risk of serious complications. It is not known whether persons with advanced chronic liver disease have a greater risk of complications from liver biopsy than patients with more mild, chronic liver disease. The safety and complications of liver biopsy were examined in patients with hepatitis C-related bridging fibrosis or cirrhosis who were enrolled in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis trial.


METHODS
Standard case report forms from 2740 liver biopsies performed at 10 study sites between 2000 and 2006 were reviewed for serious adverse events, together with information from questionnaires completed by investigators about details of biopsy techniques used at each hospital.


RESULTS
There were 29 serious adverse events (1.1%); the most common was bleeding (16 cases; 0.6%). There were no biopsy-related deaths. The bleeding rate was higher among patients with platelet counts of 60,000/mm(3) or less and among those with an international normalized ratio of 1.3 or greater, although none of the patients with an international normalized ratio greater than 1.5 bled. Excluding subjects with a platelet count of 60,000/mm(3) or less would have reduced the bleeding rate by 25% (4 of 16), eliminating only 2.8% (77 of 2740) of biopsies. Operator experience, the type of needle used, or the performance of the biopsy under ultrasound guidance did not influence the frequencies of adverse events.


CONCLUSIONS
Approximately 0.5% of persons with hepatitis C and advanced fibrosis experienced potentially serious bleeding after liver biopsy; risk increased significantly in patients with platelet counts of 60,000/mm(3) or less.
Seeff
Leonard B
LB
Division of Digestive Diseases and Nutrition, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA. seeffl@extra.niddk.nih.gov
Everson
Gregory T
GT
Morgan
Timothy R
TR
Curto
Teresa M
TM
Lee
William M
WM
Ghany
Marc G
MG
Shiffman
Mitchell L
ML
Fontana
Robert J
RJ
Di Bisceglie
Adrian M
AM
Bonkovsky
Herbert L
HL
Dienstag
Jules L
JL
D001707:Biopsy, Needle / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology*; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013921:Thrombocytopenia / Q000150:complications