Transjugular Liver Biopsy for Histological Diagnosis of Refractory Ascites and Evaluation of Portal Hypertension.

Abstract

Background/aim: Determining the etiology of underlying liver disease is important when deciding on the optimal treatment course for refractory hepatic ascites. However, percutaneous liver biopsy is not recommended for such patients. To address this issue, we investigated the safety profile and diagnostic efficacy of wedged hepatic venous pressure (WHVP) measurement and transjugular liver biopsy (TJLB) to facilitate the histological diagnosis and evaluation of portal hypertension in cases of refractory ascites.

Patients and methods: The clinical background, laboratory diagnostic success rate, complication rate, and survival-related factors were analyzed in 24 patients with refractory ascites, extracted from among 314 patients who underwent TJLB between May 2002 and December 2024.

Results: Overall, 15/9 cases were male/female, respectively, the mean age, Alb level, MELD score, and WHVP were 67.21 years, 2.61 g/dl, 24.917, and 38.24 cmH2O, respectively. The overall diagnostic success rate of the TJLB procedure was 100.0%, providing sufficient material for diagnosis. No severe complications were observed. Cases of ascites caused by chronic myelomonocytic leukemia (n=1) and amyloidosis (n=4) had a poor prognosis, whereas cases caused by autoimmune hepatitis (AIH) had a good prognosis following disease treatment. AIH and Child-Pugh class B were identified as factors contributing to survival.

Conclusion: TJLB has the advantage of allowing the assessment of portal venous pressure with WHVP, facilitating the histological diagnosis in cases of refractory ascites. TJLB could thus represent an alternative to percutaneous liver biopsy in patients with ascites, possibly contributing to better prognosis by allowing treatment strategy decisions according to the underlying disease cause.