Transjugular Liver Biopsy and Hepatic Vein Pressure Gradient

• Transjugular liver biopsy (TJLB) is an alternative to a percutaneous liver biopsy.
• Specimens obtained from TJLB have a reduced risk of hemorrhage compared to those obtained with the percutaneous technique. ‹ Its clinical role has expanded due to the possibility of performing hemodynamic evaluation.
• TJLB is indicated in failed percutaneous liver biopsy or in a patient with a contraindication to percutaneous biopsy, in coagulopathy (a most common indication), massive ascites, patients requiring hemodynamic evaluation as part of their diagnostic workup, morbid obesity, liver transplant or with serum bilirubin >6, in patients undergoing a TIPS procedure.
• There are no real contraindications for a TJLB. However, relative contraindications include a lack of suitable venous access and a biopsy of a focal lesion.
• An international normalized ratio (INR) of >2 and a platelet count of 2.5 times the control and the platelet count is 10 mmHg indicates CSPH.
• Patients with CSPH are at high risk of developing clinical complications, including variceal bleeding, ascites and encephalopathy.
• While a biopsy sample represents only a small liver area, serial HVPG measurements characterize the overall degree of fibrosis or cirrhosis, reflecting an underlying heterogeneous disease process.
• HVPG is the gold standard for PHT measurement, and its safety and reproducibility are well-proven. It has become an important diagnostic and prognostic tool and can be adopted in routine practices as per the Baveno VII consensus.