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Published on: June 18, 2020
Complications of percutaneous liver biopsy in children
M B Cohen1, H H A-Kader, D Lambers
1Division of Gastroenterology and Nutrition and Clinical Research Center, Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Liver biopsy complications, particularly bleeding requiring transfusion, are more common in children than previously thought. Children with cancer or undergoing bone marrow transplant face significantly higher risks of bleeding and death.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Interventional Radiology
Background:
- Liver biopsy is a crucial diagnostic tool in pediatric patients.
- Understanding complication rates and risk factors is essential for patient safety.
Purpose of the Study:
- To determine the frequency and types of complications following percutaneous liver biopsy in children.
- To identify risk factors predictive of these complications.
Main Methods:
- Retrospective review of medical records for pediatric patients (1 week to 28 years) undergoing percutaneous liver biopsy.
- Analysis of 469 patient charts from a 6-year period (1981-1986).
Main Results:
- Overall major complication rate was 4.5%, with bleeding requiring transfusion being the most common (2.8%).
- Patients with cancer or bone marrow transplantation had a nearly fivefold increased risk of transfusion (P=0.02).
- All three deaths occurred in the high-risk group (cancer/transplant patients), with two from disseminated intravascular coagulation and one from bleeding (P<0.001).
Conclusions:
- Bleeding requiring transfusion is the most frequent complication of pediatric liver biopsy.
- Children with cancer or those who have undergone bone marrow transplantation are at significantly higher risk for bleeding and mortality after liver biopsy.
Abstract:
To determine the frequency and nature of complications after liver biopsy and whether risk factors could be identified to predict these complications, the medical records of all patients (age, 1 week to 28 years) who underwent a percutaneous liver biopsy at Children's Hospital over a 6-year period (1981-1986) were reviewed. Data were collected from 469 (97%) of 483 eligible charts. Twenty-one patients (4.5%) experienced major complications including bile leak (n = 3, 0.6%), prolonged drainage of ascitic fluid (n = 1, 0.2%), pneumothorax (n = 1, 0.2%), bleeding requiring transfusion (n = 13, 2.8%), and death (n = 3, 0.6%). A subgroup of patients (n = 37) with cancer or bone marrow transplantation was found to be at a nearly fivefold greater risk for transfusion than patients with other diagnoses (P = 0.02). All three deaths in previously stable patients occurred in this same high-risk group of patients with cancer or bone marrow transplantation (P less than 0.001). Two deaths resulted from disseminated intravascular coagulation and one from bleeding. Diagnosis, age, number of percutaneous passes, and prebiopsy coagulation studies were not predictive of subsequent complications. It is concluded that bleeding that requires transfusion is the most common liver biopsy complication and that it occurs more frequently in children than previously reported. Children with cancer or those who have undergone bone marrow transplantation are at a greater risk for bleeding and death following percutaneous liver biopsy.
