title: Ultrasound-guided Liver Biopsies in Children: A Single-center Experience and Risk Factors for Minor Bleeding.
abstract: The aim of the study was to analyze the institution's experience in ultrasound-guided liver biopsies performed on children and identify risk factors for complications, following a previous study performed in our institution.
  
  
  
  Retrospective analysis of a consecutive series of ultrasound-guided pediatric liver biopsies, between 2011 and 2016. Demographic and anthropometric data, biopsy indications, international normalized ratio (INR) and platelet count, biopsy technique, complications, and pathologic outcomes were recorded.
  
  
  
  A total of 228 procedures were performed on 203 children with a median age of 9.25 years (range: 0.08-18.42): 107 girls (47%) and 121 boys (53%). One hundred twenty-seven biopsies were performed on transplanted livers (55.7%) and 101 on native livers (44.3%). There were 27 cases with immediate complications (11.84%), all due to minor bleeding. There were no major complications. Increasing needle passes were shown to be a reliable predictor for bleeding (P = 0.0023), whereas transplanted livers predicted protection against bleeding (P = 0.0007). Age younger than 3 years, bodyweight <16 kg, platelet count <70 g/L and INR >1.25 revealed association with increased bleeding incidence, but no predictive value.
  
  
  
  Ultrasound-guided liver biopsies in pediatric age are a safe procedure with a high diagnostic yield. Increasing the number of needle passes predicts a higher incidence of minor bleeding. Other factors to account for minor bleeding risk may include age younger than 3 years, bodyweight <16 kg, platelet count <70 G/L, and INR >1.25. Transplanted livers present a lower bleeding risk.
authors.affiliation: *Serviço de Imagem Médica, Polo Hospital Pediátrico †Unidade de Transplantação Hepática, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Bilreiro
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Noruegas
authors.forename: Isabel
authors.initials: I
authors.lastname: Gonçalves
authors.forename: Ângela
authors.initials: Â
authors.lastname: Moreira
mesh_terms: D000293:Adolescent; D062005:Biopsy, Large-Core Needle / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects* / Q000379:methods; D007223:Infant; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D018084:Ultrasonography, Interventional / Q000009:adverse effects* / Q000379:methods