Same day outpatient transjugular liver biopsies in haemophilia

Patients with haemophilia are at increased risk of hepatitis C infection because of prior transfusion of blood products. Virtually all haemophiliacs who received pooled blood products before the mid-1980s have been infected with hepatitis C. A liver biopsy is important to identify the extent of liver disease, and to help determine the necessity of interferon therapy. With factor replacement, in-hospital liver biopsy is safe. Thirty patients with haemophilia were evaluated for chronic hepatitis C infection. Eleven patients subsequently underwent successful transjugular liver biopsy in the outpatient setting after appropriate factor replacement. Mean +/- SD pre- and posthaemoglobin values were 15.8 +/- 0.79 and 14.4 +/- 0.71 g dL(-1) (P = ns). There was no significant change in heart rate, systolic or diastolic blood pressure during the monitoring period (P = ns) and no major complication was noted in perioperative follow-up. The mean length of the liver biopsy specimens was 1.7 +/- 0.3 cm, mean grade was 2 +/- 0.6 and mean stage was 2.3 +/- 1.2. Our experience demonstrates that outpatient transjugular liver biopsy can be safely performed in patients with haemophilia in the outpatient setting, avoiding the cost and need for hospital admission.

Recurrent hepatitis C following liver transplant: diagnosis, natural history, and therapeutic options

Hepatitis C virus (HCV) related cirrhosis is the most common indication for orthotopic liver transplantation (OLT). Updated data suggest worse long-term outcomes for those transplanted with HCV than those transplanted for other indications. Re-infection with HCV post-OLT is universal, therefore diagnosis of recurrence should be based on histological findings in the setting of persistent viremia. Variables associated with worse outcome of recurrent disease include early recurrence, degree of immunosuppression, and donor age. Antiviral therapy has been used in the prevention and treatment of recurrent disease, and can be initiated prior to transplantation, prophylactically after transplantation, and during recurrence. Preliminary studies of pre-transplantation treatment demonstrate virological responses, but tolerance is common. Higher efficacy has been associated with combination therapy for recurrent disease. Adverse effects limit its widespread use.