LIVER-BIOPSY IN LIVER-TRANSPLANTATION - NO ADDITIONAL RISK OF INFECTIONS IN PATIENTS WITH CHOLEDOCHOJEJUNOSTOMY

Background/Aims: This study aimed to determine whether there is an inc reased infectious risk following liver biopsy in liver transplant pati ents with choledochojejunostomy. Methods: We evaluated the incidence o f liver-biopsy-related sepsis in a consecutive series of 27 patients w ho underwent choledochojejunostomy, either during the transplant proce dure (17 patients) or later following biliary complications (10 patien ts), We evaluated another 138 patients as a control group who had orth otopic liver transplantation during the same period and underwent duct -to-duct anastomosis, All liver biopsies had routine, prior ultrasound evaluation to detect dilated biliary ducts. Results: In the 27 patien ts who underwent choledochojejunostomy, 96 liver biopsies were perform ed: the sepsis rate was 3.12% per biopsy (n=96) or 7.4% per patient (n =27). However, despite a normal ultrasound, subsequent ERCP demonstrat ed biliary obstruction in one patient, Thus the rate of sepsis was 2.1 % per biopsy or 3.7% per patient. In the control group 338 liver biops ies were performed: the sepsis rate was 1.5% per biopsy (n=338) or 2.9 % per patient (n=138). The difference was not significant, All septic episodes had positive blood cultures for a single enteric microorganis m, and all responded to antibiotics, Conclusions: Our data do not sugg est that liver-transplanted patients with choledochojejunostomy are mo re at risk of sepsis following liver biopsy, providing there is no ''o ccult'' biliary obstruction; therefore, they do not require prophylact ic antibiotics as has been suggested by other authors.