Assessment of Safety and Efficacy of Transjugular Liver Biopsy As a diagnostic Method in Adult Patients with Congenital Bleeding Disorders with HCV Infection

Background/ Liver biopsy in patients with congenital bleeding disorders (CBD) and hepatitis C virus (HCV) infection is still a challenge between risk of procedure and effect of biopsy result on management. We did transjugular liver biopsy (TJLB) on 12 patients with CBD with chronic HCV infection and elevated liver enzymes to determine its safety, efficiency and therapeutic conse-quences. All patients were men, with a median age of 29.5 years (14–54 years). Eleven patients had haemophilia A (10 severe, one moder-ate) and one patient had factor XIII deficiency, with no titer of inhibitor. HCV genotyping was carried out with type 1a (7 patients), type 1b (2 patients), type 3 (2 patients) and genotype 1a and 1b (1 patient). HIV and HBV co-infection was negative in all patients. We used the modified Ross needle with 100% transjugular access rate to the hepatic veins and 92% success rate in tissue obtaining. The specimen obtained was satisfactory but limited for histopathologic diagnosis in 54.5%. Mild hepatitis was revealed in 4 patients (36.4%), moderate hepatitis in 5 (45.4%) and extended fibrosis or cirrhosis in 2 (18.2%). There were 2 procedure-related complications (16.6%). The major limitation of technique was low number of portal area in liver biopsies. TJLB with some limitations is useful in patients with CBD. Transjugular approach to liver biopsy is a safe and effective alternative to the percutaneous approach in patients with CBD and could be requested to determine their liver prognosis and considered for diagnostic liver biopsy prior to anti-HCV therapy.