353 - Transjugular Liver Biopsy in Pediatric Patients

Purpose: Data on transjugular liver biopsy (TJLB) in children are limited. This study evaluates TJLB utility, risks, and clinical impact in children at a tertiary, liver-transplant medical center.

Materials and Methods: A retrospective review of pediatric TJLBs (≤18 years, 11/1/1996–6/1/2025) assessed indications, success, complications, histology adequacy, and management changes.

Results: 129 pediatric TJLBs were performed in 111 children (mean age 11.7 ± 4.9 years). Technical success yielding pathologic diagnosis was 100%. 66.7% procedures yielded >11 portal tracts; all were diagnostic. Three (2.3%) TJLB had minor complications (SIR Class C): hemoperitoneum (n=2) and duodenal hematoma (n=1). Patients were managed with blood transfusion; no active hemorrhaging was seen on post-procedural imaging and no additional intervention was needed. Risk of complication did not correlate significantly with pre-procedural INR, platelets, or hemoglobin. Mean fluoroscopy time was 9.5 ± 9.5 minutes. Average INR was 1.4 ± 0.4 and platelets and 142 ± 133 x10⁹/L at TJLB. Mean hemoglobin change 4 hours post-procedure was -0.3 ± 9.7 g/dL. Four (3%) patients weighed < 10 kg, 30 (23%) weighed 10–30 kg, and 95 (74%) >30 kg. Weight was not associated with fluoroscopy time, success, or complications. Forty biopsies (31%) were in liver transplant patients (15 split, 25 orthotopic). Fluoroscopy times averaged 4.7 ± 4.6 (split) and 7.7 ± 6.3 minutes (orthotopic, p=0.1). There were no statistically significant difference or complications (0%).

Conclusion: TJLB is a safe, effective procedure with 100% tissue yield and a low (2.3%) minor complication rate in children of various weight and in those with split or orthopic transplant, supporting its value as a reliable diagnostic tool in pediatric hepatology.