Transjugular liver biopsy and hepatic venous pressure gradient measurement in patients with and without liver cirrhosis

Abstract

Background: Transjugular liver biopsy (TJLB) and hepatic venous pressure gradient (HVPG) measurement are diagnostic procedures for patients with acute and chronic liver diseases. Technical execution of TJLB and HVPG may be challenging in patients with advanced liver disease.

Objective: We studied consecutive TJLB and HVPG procedures and investigated technical success, complications, quality of biopsies, indications and treatment changes in patients with and without liver cirrhosis.

Methods: In the study period from 2010 to 2018, 575 consecutive TJLB and HVPG procedures were analyzed. Demographic characteristics, procedure-related and follow-up data were extracted from medical records.

Results: In total, 259 (45%) patients were diagnosed with liver cirrhosis whereas 316 (55%) patients had no evidence of advanced chronic liver disease. Technical success of TJLB was significantly higher in patients without liver cirrhosis (287; 92%) compared to patients with liver cirrhosis [184; 76.7% (P = 0.001)]. Technical success of HVPG measurement was not different between both groups (P = 0.553). Liver biopsy specimens were significantly shorter in patients with liver cirrhosis (P = 0.001). Medical therapy was adjusted in 163 (28.4%) patients. In patients with liver cirrhosis, results of TJLB led less frequently to therapy initiation or adjustment compared to patients without liver cirrhosis (P = 0.001). In multivariate analysis, liver cirrhosis (Exp(B) 1.866; P = 0.012), alanine aminotransferase (Exp(B) 0.248; P < 0.001) and INR (Exp(B) 0.583; P = 0.027) were independently associated with treatment change.

Conclusion: Technical success and therapeutic decisions of TJLB are directly linked to presence or absence of liver cirrhosis.