Azoulay D, Raccuia J S, Roche B, Reynes M, Bismuth H
Hepatobiliary Surgery and Liver Transplantation Center, Paul Brousse Hospital, Villejuif, France.
Transplantation. 1996 Feb 15;61(3):406-9. doi: 10.1097/00007890-199602150-00015.
Conventional percutaneous liver biopsy in the early postoperative period, within 30 days, following liver transplantation may be impossible due to coagulopathy and/or ascites. The use of transjugular liver graft biopsy (TJLB) in this setting is an attractive alternative in that a tissue diagnosis can be obtained despite the relative contraindications for percutaneous biopsy during this period. During the early posttransplant period, 124 TJLBs were performed in 105 liver patients, the majority (89%) of whom had standard liver transplantation without preservation of the native inferior vena cava; the others (11%) had the native inferior vena cava intact. The technical success rate was 87%, with adequate specimen for definitive diagnosis in most instances (86%), which included both rejection (61%) and nonrejection (39%) diagnoses on final histopathology. The biopsy diagnosis influenced clinical management in the majority of cases (65%), with decisions made to perform retransplantation (3%), to influence initiation of antirejection therapy (59%), and to institute antiviral therapy (3%). There was no morbidity or mortality associated with TJLB and it is feasible, safe, and effective in the early period after liver transplantation.
由于凝血功能障碍和/或腹水，肝移植术后30天内进行常规经皮肝活检可能无法实现。在此情况下，经颈静脉肝移植活检（TJLB）是一种有吸引力的替代方法，因为尽管在此期间经皮活检存在相对禁忌证，但仍可获得组织诊断。在移植后早期，对105例肝病患者进行了124次经颈静脉肝移植活检，其中大多数（89%）接受了未保留肝下腔静脉的标准肝移植；其他患者（11%）的肝下腔静脉完整。技术成功率为87%，在大多数情况下（86%）获得了足以进行明确诊断的标本，最终组织病理学诊断包括排斥反应（61%）和非排斥反应（39%）。活检诊断在大多数病例（65%）中影响了临床管理，决定进行再次移植（3%）、影响抗排斥治疗的启动（59%）以及开始抗病毒治疗（3%）。经颈静脉肝移植活检没有相关的发病率或死亡率，并且在肝移植后的早期是可行、安全和有效的。
