Clinical Significance of Transjugular Liver Biopsy in Liver Dysfunction During Immune Checkpoint Inhibitor Therapy

Transjugular liver biopsy (TJLB) is indicated for patients unsuitable for percutaneous liver biopsy owing to coagulation abnormalities or ascites. While immune checkpoint inhibitors (ICIs) are cornerstone therapies for cancers, immune-related adverse events (irAEs) remain a concern. Specifically, concurrent pancytopenia or coagulation abnormalities often preclude percutaneous biopsy in these patients. The aim of this study was to evaluate the outcomes and utility of TJLB in patients with suspected ICI-induced liver injury.

This study involved seven patients who developed liver injury while receiving ICI therapy at our institution and required histological diagnosis via TJLB. All TJLB procedures were performed using the right internal jugular vein approach.

The mean age of patients (six male and one female) was 68.14±9.61 years. Among patients with liver cancer receiving ICIs, two received atezolizumab plus bevacizumab and two received durvalumab plus tremelimumab. Among patients with lung cancer, three received pembrolizumab. Laboratory findings at TJLB were as follows: alanine aminotransferase, 553.28±903.76 U/l; aspartate aminotransferase, 440.57±571.05 U/l; total bilirubin, 4.82±4.77 mg/dl; and gamma-glutamyltransferase, 267.42±320.21 U/l. In one patient with liver cancer, liver dysfunction worsened due to underlying liver disease. Both patients with liver cancer treated with durvalumab plus tremelimumab had confirmed irAEs. One patient with lung cancer had confirmed irAEs, whereas another was diagnosed with drug-induced liver injury. One patient with lung cancer treated with later-line ICIs showed no tumor lesions in the liver on imaging but had elevated wedged hepatic venous pressure, indicating liver dysfunction due to tumor infiltration.

TJLB is a valuable tool for the early diagnosis of ICI-related liver injury and establishing treatment guidelines based on the underlying etiology.