Purpose or Case Report: Ultrasound guided percutaneous liver biopsy is frequently performed in pediatric patients. Published post-biopsy complication rates range between 0.3 - 3.3% according to Society of Interventional Radiology Standards of Practice. Post-biopsy tract embolization has been prophylactically used to theoretically decrease the bleeding risk, but is not the current standard of care at our institution. The goal of this study is to determine if there is a need for prophylactic biopsy tract-embolization after ultrasound guided liver biopsy in the pediatric population.

Methods & Materials: Retrospective chart review on patient’s ages 0-18 years, who received an ultrasound guided percutaneous liver biopsy for routine standard of care between January 2008 and August 2016 at dedicated academic pediatric institution. Clinical, radiographic, procedural and pathology data were collected on each subject meeting inclusion criteria. Subjects with a focal liver mass were excluded. Local institutional review board approval was obtained for this study.

Results: A total of 512 liver biopsy procedures on 209 subjects were evaluated for post-procedural complications. The average age was 8.3 (SD ± 6.1) years and a little over half of the patients were male (n=119, 56.5%). Majority of patients had a liver biopsy for increased liver enzymes (n=115, 55.8%) and 74 (5.4%) for prior liver transplant. Pre- and post-biopsy hemoglobin (Hgb) values were evaluated and one (0.2%) subject experienced a Hgb drop of >2.0 g/dL, twenty (3.6%) subjects experienced a Hgb drop of >1.0 g/dL and six (7.23%) subjects did not have a change in Hgb pre- and post-biopsy. We examined the average platelet count and INR for biopsies resulting in a drop of >1.0 g/dL. No statistically significant difference was observed between the pre- and post-procedure coagulation labs between patients with and without an Hgb drop of >1.0 g/dL. Average platelet count drop was 230 mL for those with >1.0 g/dL drop in Hgb and 226.5 mL for those without a change in Hgb (p=0.918). INR (normal <1.10) was 1.05 for those with >1.0 g/dL drop in Hgb and 1.03 for those without >1.0 g/dL drop (p=0.459).
Conclusions: Ultrasound guided liver biopsies are safe and routinely performed by pediatric interventional radiology practices. Our results indicate that prophylactic track-embolization in pediatric liver biopsy patients is not necessary in patients with normal coagulation parameters.