Percutaneous Transplant Liver Biopsies: Does Biopsy Needle Gauge Matter?

Introduction This study evaluates coaxial core needle size (17/18G vs 19/20G) and sample adequacy in liver transplant biopsies. Materials and methods This was an Institutional Review Board (IRB)-approved retrospective study of 397 percutaneous transplant liver biopsies performed over four years with 17G/18G or 19G/20G coaxial and core needles. Medical records were reviewed for needle size, number of cores, tract embolization, complications, and sample adequacy by pathology. Statistical significance was determined using a combination of t-tests and chi-squared tests with a significance level less than 0.05. Results There were 257 18G core biopsies and 140 20G biopsies. Sample inadequacy was noted in 3/257 of the 18G biopsies and 19/140 of the 20G biopsies (p<0.0001). The mean number of cores taken was 3.17±0.72 and 3.06±0.81 for 18G and 20G biopsies, respectively (p=0.14). There was no significant difference between the two groups regarding the number of cores taken in the adequate or inadequate samples. Tract embolization was performed in 353/397 biopsies. One clinically significant bleeding complication was noted in a procedure done with a 20G needle with two core biopsies. No other major complications were noted. Conclusion Random transplant liver biopsies performed with coaxial 17G/18G core biopsy needles are more likely to provide adequate results than biopsies performed with 19G/20G needles. The risk of complications in transplant liver biopsies is low.