LIVER BIOPSY PROCESS

Following liver transplantation, patients undergo serial biopsies to provide material for histologic evaluation. Under informed consent, a portion of the specimen may also be used for research purposes. The following presentation provides an overview of the biopsy process and a look at the amount of material available for clinical virology, gene expression, and proteomic analyses.

	Blood Tests The process begins with blood tests to measure serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels.
	Ultrasound Ultrasound is then used to image the liver and assist the clinician in proper needle placement. A transducer is moved over the area, producing a display that is viewed on the monitor.
	Marking Biopsy Spot Based on the ultrasound image, the spot for needle placement is marked.
	Printing Ultrasound Image Selected images are retained for documentation purposes.
	Biopsy Procedure The patient is then prepared for the procedure, which is performed in an outpatient setting.
	Evaluation The patient's chart and ultrasound images are evaluated by the attending physician.
	Preparation The target area is disinfected.
	Local Anesthetic A local anesthetic is injected to minimize discomfort.
	Biopsy Needle Calibration The length of the biopsy needle is calibrated based on the ultrasound findings.
	Biopsy The biopsy needle is inserted to the appropriate depth and a sample of tissue is drawn into the needle.
	Aftercare The patient is instructed to rest for 4 to 6 hours, during which time pulse, blood pressure, and respiration are monitored.
	After the Procedure Guidelines are provided about activity restrictions following the procedure.
	Tissue Evaluation The biopsy specimen is approximately 0.8 mm in diameter and 3 to 4 cm in length. A 2-cm portion of the specimen is sent to Pathology for histologic evaluation.
	Research The remainder of the biopsy specimen is available for research activities, including clinical virology, gene expression analysis, and proteomics.