THE NATURE OF COMPLICATIONS FOLLOWING LIVER-BIOPSY IN TRANSPLANT PATIENTS WITH ROUX-EN-Y CHOLEDOCHOJEJUNOSTOMY

Liver biopsy is an important diagnostic tool in the management of pati ents following orthotopic liver transplant. We evaluated complications following percutaneous liver biopsy in a group of liver transplant pa tients who had Roux-en-Y choledochojejunostomies fashioned as part of their biliary reconstruction during liver transplantation. Complicatio ns were divided into two major groups: septic complications (including fever, symptomatic bacteremia, cholangitis, infected hematoma and hyp otension related to sepsis) and bleeding (defined as hypotension requi ring volume expansion greater than 500 cm(3) or blood transfusion, hem othorax, intrahepatic or peritoneal hemorrhage and hemobilia occurring within 1 wk of liver biopsy). One hundred ninety-two biopsies were pe rformed in 46 patients with choledochojejunostomies, and 118 biopsies were carried out in an age- and sex-matched control group of patients with choledochocholedochostomy biliary anastomosis. There were no sept ic complications in the choledochojejunostomy patients and one (0.32%) septic complication in the choledochocholedochostomy patients (NS). E ight bleeding complications occurred (2.6%) in eight patients (8.3%). Five (2.6%) occurred in five (10.8%) of the choledochojejunostomy pati ents, vs. three (2.5%) in three (6.5%) choledochocholedochostomy patie nts (NS). None of the bleeding complications required surgical interve ntion or was fatal. We conclude that liver biopsy in posttransplant pa tients with Roux-en-Y choledochojejunostomies is a safe procedure and that the incidences of complications were similar in our two groups. T he negligible incidence of septic complications in the choledochojejun ostomy patients does not appear to warrant the administration of proph ylactic antibiotics, as has been previously suggested.