Application of percutaneous liver biopsy in living donor liver transplantation

Percutaneous liver biopsy (PLB) is one of the most important procedures to obtain tissue for assessment of the liver's condition, both for potential donor evaluation and for graft pathological identification in living donor liver transplantation (LDLT). To describe a skillful technique with different situations on LDLT, a series of PLB procedures was developed as a teaching program from clinic to the bench since 1988 to 2012. A total of 2054 episodes of PLB were reviewed in the current series including potential donor evaluation in 8.3% (169), selected liver biopsy in 77.2% (1586), dual graft biopsy in 1.2% (26), pediatric liver biopsy in 8.8% (181), difficult biopsy in 4.2% (87), and intra-abdominal biopsy in 0.24% (5). For infant and pediatric recipients, intravenous general anesthesia or sedation was necessary. The acute rejection rate was 15%, which included 64.6% in mild and 35.4% in moderate degree. The overall complication rate was 0.097%. A satisfactory liver biopsy specimen containing at least six to eight portal triads was necessary, indicating that the ideal biopsy sample should consist of at least a 2-cm length of liver tissue. PLB technique is an important component of the continuing medical education of junior transplant hepatologists and surgeons who want their practice to benefit from a familiarity with new knowledge from clinical practice to the laboratory bench in all its dimensions on living donor liver transplantation.