Abstract:
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Purpose: ALF treated with conservative therapy has a poor prognosis, although individual survival varies greatly. In these patients, the eligibility for orthotopic liver transplantation (OLT) must be quickly established. The aim of this study was to assess the role of TJLB for the management of patients with ALF clinical presentation.
Methods and Materials: Fifteen consecutive patients with ALF clinical presentation and contraindications to percutaneous liver biopsy were referred for TJLB at a single liver transplant center during a 45-month period. The Cook Quick-Core biopsy needle was used. Clinical data, procedural complications and histology findings were evaluated.
Results: The mean age was 44 years; 10 patients were females. Clinical data at the admission were prothrombin activity 32±15%, INR 2.4±1.2, AST 2121±1746, ALT 27111±417, bilirubin 13.3±6.7, lactate 4.8±2.9. Six patients had severe thrombocytopenia, and six ascites. Etiology was VHB in 7 patients, drug toxicity in 3, Wilson´s disease in 1, and unknown in 4. TJLB was technically successful in all patients. There were no procedure-related complications. The mean number of cores was 1.8 (range = 1-4). Tissue specimens were satisfactory for diagnosis in all cases (mean core tissue length 1.2±0.4 cm). In 14 of 16 patients, the initial clinical diagnosis was confirmed by TJLB; in 2 patients the initial diagnosis was altered for the presence of cirrhosis. Seven patients with necrosis < 60% were successfully treated with medical therapy; five patients with submassive or massive necrosis (85-100%) were treated with OLT; three patients died, two had cirrhosis and one submassive necrosis (80%). There was a perfect correlation (r=0,972, p<0.0001) between frozen section examination and permanent necrosis on the percentage of hepatocellular necrosis. The average time for TJLB and frozen section examination was 80 minutes.
Conclusion: In patients with ALF clinical presentation, the presence of submassive or massive liver necrosis and cirrhosis are predictors of poor prognosis. TJLB using an automated device and frozen section can be a quick and effective tool to assist clinical decision making, especially in deciding patient selection and the best timing for OLT.
Luca MD, A,
Contribution of Trans-Jugular Liver Biopsy (TJLB) in Patients with Acute Liver Failure (ALF) Clinical Presentation. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3104156.html
