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Hepatitis C: My First Liver Biopsy
Living with Hepatitis C means that at some point you'll have to decide whether or not to undergo a liver biopsy. Robert Kolling describes what his was like.

By Robert Kolling

To make a long story short, I was diagnosed with Hepatitis C in early 1999, and later cirrhosis of the liver. I developed end-stage liver disease in late 2002 and had a liver transplant on November 11, 2002.

Throughout this period, I never had a liver biopsy. I somehow skated all of those years. All my recent monthly blood test results have been good. Since liver biopsies are invasive, and they do have some risks, such as internal bleeding, puncturing of the lung or gallbladder, infection, and mild to moderate pain, my goal was to put this off as long as I could

Then last month, my luck ran out. My hepatologist at
Rush University Medical Center informed me that he would like to have this test run on me. He said it was precautionary to make sure there were no underlying problems that wouldn’t show up on the routine blood tests. Simply stated, a liver biopsy is a procedure for the diagnosis of abnormal liver conditions.

So I made the appointment with the hospital for this out-patient procedure. I was told to schedule the whole day, and to bring a driver. No food or drink after midnight. I was very apprehensive about this, as most people tend to be. There are two things that made me subject myself to this torture. First, the care I receive at Rush is first class, and my entire post-transplant team has kept me very much alive these last few years. I was getting used to that and I respect their track record. Second, I re-read the letter that I had received from the wife of my organ donor the night before my test. That, in itself, was enough inspiration for me. A few needles here and there poking me was nothing compared to what others had gone through to keep me alive. Time to suck it up.

The procedure began with the insertion of an IV into the back of my hand. I tried to persuade the nurse against this, but my doctor explained that in the unlikely event that some internal bleeding were to occur during the test, they did not want to be searching for a vein later to insert an IV in order to treat the bleeding. Then a topical numbing shot was given to an area on my side between two ribs. This area was identified by my hepatologist and verified via ultrasound as being the most advantageous to enter. A couple more needles were inserted to inject local anesthesia inside of me. Then a gun-type needle was inserted and shot into my liver. This retrieved a core of tan-red tissue measuring 2.0 cm in length.

I then had to lay on my right side for an hour and then on my back for two more hours. My rib cage felt like someone had whacked me with a baseball bat, but a couple of Tylenols relieved the pain. I was then released and took my wife to Chinatown for a late lunch. Piece of cake.

To know or not to know
I’m not the kind of guy who wants to know too much about these things until it’s over, when I no longer have the opportunity to chicken out. It wasn’t until the day after the procedure that I did some research.

It turns out that biopsies are important for several reasons. First it helps your medical team determine exactly where you and your liver are in the course of the disease process (grade and stage). It is used to decide what type, if any, therapies are appropriate. The three main things that are looked for are inflammation, fibrosis, and cirrhosis. The biopsy may also reveal other histological and pathological findings, such as the presence of lymphoid nodules, damage to the small bile ducts, and/or the presence of fat.

If there is fibrosis present, the levels of staging, which range from stage 0 (normal), to stage 4 (cirrhosis), can be detected. Stage 1 is mild fibrosis, stage 2 is moderate fibrosis, and stage 3 is severe or bridging fibrosis. Once a patient has stage 3 or stage 4, the risk of liver cancer and liver failure are increased. Stages 3 and 4 fibrosis are life threatening, while stages 0, 1, and 2 are not.

While there are alternative tests available, such as Fibroscan and HCV Fibrosure, they are not substitutes. Liver biopsies have been performed for over 115 years and are still considered the “gold standard of liver tests.” However, more research is being given to other non-invasive methods. The market timing for the non-invasive tests is good, considering that doctors are increasingly open to alternatives to biopsy. Acceptance will be easier to come by if research bears out manufacturers’ claims that they are at least as accurate as the biopsy.

Decisions
There are many decisions to be made if you have been diagnosed with hepatitis C, such as whether or not to have a liver biopsy, and deciding upon the various treatment options that are best for you and whether or not to even begin a treatment program.

I am merely passing along my individual experience and findings as well as a brief overview of what is involved with a liver biopsy. You need to discuss this with your heath care provider. These are decisions that you, your doctor, and your family need to discuss.

Related articles:
Hepatitis C: What's It All About?
Gunned Down in Basic Training

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