When is transjugular liver biopsy indicated and preferred over percutaneous liver biopsy?
Because a transjugular liver biopsy specimen is obtained from within a hepatic vein, bleeding complications resulting from transgression of the liver capsule may be avoided. The transjugular procedure is indicated for patients with coagulopathy or platelet deficiency. Platelet dysfunction because of renal failure may also be an indication. In addition, any other issue that may make percutaneous biopsy difficult or risky (e.g., presence of ascites) would be a potential indication for transjugular liver biopsy. Because transjugular biopsy cannot generally be used to target a specific liver lesion, it is used only to obtain a tissue diagnosis for medical (diffuse) liver disease such as cirrhosis, viral hepatitis, or transplant rejection. Transjugular liver biopsy may also be preferred when both biopsy and hepatic venous pressure measurements are required, since the pressures may be obtained from the same hepatic vein that is used as access for the biopsy. Hepatic venous pressure measurements are used to diagnose portal hypertension and/or to gauge its severity.