You are going to have a biopsy in the Transplant Clinic. This handout will explain what is going to happen, how to get ready, and what you will do after the biopsy.
Let us know if you take any blood thinners such as Coumadin® (warfarin), Plavix® (clopidogrel), Xarelto (rivaroxaban), or Eliquis (apixaban) when we schedule the biopsy. You will need to stop these before the biopsy. You should never stop blood thinning pills without talking with your doctor first. Here are some guidelines:
Coumadin® (warfarin),Plavix® (clopidogrel), and Brilinta® (ticagrelor) should be stopped 5 days before the biopsy.
Effient® (prasugrel) should be stopped 7 days before the biopsy.
Pradaxa® (dabigatran) should be stopped 2 days before the biopsy.
Xarelto® (Rivaroxaban) and Eliquis (apixaban) should be stopped 24 hours to 72 hours before the biopsy. Discuss this with your planner. The timing is different depending on why you take this medicine.
Again, do not stop any of these medicines without first talking to your doctor.
What Is a Transplant Liver Biopsy?
If your liver blood tests are going up, your doctor will often want to do a biopsy of your liver. This could be due to acute or chronic rejection, obstruction or other liver problems. We will remove a small piece of tissue and look at it under a microscope. A needle is put through the skin and into the liver to obtain the liver tissue. Your skin will be numbed before the biopsy so it should not be painful.
The biopsy takes less than fifteen minutes but plan to spend most of the day in the clinic.
How to Prepare for Your Liver Biopsy
Do not take aspirin or aspirin products 7 days before the biopsy. Do not take other drugs such as ibuprofen, Advil®, Motrin®, Naprosyn®, and Feldene®.
You will not be able to drive home after the biopsy. You MUST bring a driver with you. You should not drive or make important decisions until the next day. If you plan to stay in a hotel after the biopsy, you will need to have someone to stay with you.
You will be resting for 4 hours after the biopsy. We suggest you wear loose, comfortable clothes. You may also want to bring a book to read or some other quiet project to do while you are resting.
Do not eat any solid foods after midnight the night before the biopsy. You may have clear liquids for breakfast. If you have diabetes, talk with your doctor about your insulin or oral medicine dose for the night before and the morning of the biopsy.
You may take your morning medicines unless you are told not to. If you are having a cyclosporine or tacrolimus level drawn the morning of the biopsy, please bring the dose with you. You can take it after the blood is drawn.
If you are an HMO member, you will need a referral.
The Morning of the Biopsy
Please report to the hospital lab at 8:00 am (unless you have been told to arrive at a different time). Your orders will be in the lab. This will include a test to make sure that your blood clotting factors are within the normal range.
Next, report to the Transplant Clinic. You will have an IV started. You will get fluids through your IV.
You will also be told about the biopsy, its purpose and risks. You will then be asked to sign a consent form.
After all the lab results are back and reviewed, you may be given oral medicine to help you relax. The biopsy will be done using an ultrasound.
After the Biopsy
You will remain in the recovery area and lie quietly for 4 hours. Nurses will watch closely for any problems. Your family may join you in the room during this time.
The biopsy site will be covered by a Band-Aid®. It will also have a sandbag on it for the first hour.
You will have nothing to eat or drink for 1-2 hours after the biopsy. Then you may have lunch. If you are on a special diet, please let the nursing staff know when you arrive in the clinic.
We should have the results of the biopsy before you leave. We will talk with you about your plan of care. Depending on the results, you may be admitted to the hospital. If not, you will be able to leave when the doctor decides that you are ready. Please bring your medicines and an overnight bag with you, in case you need to stay.
About 3 hours after the biopsy, a blood sample will be taken to check your hematocrit. This helps staff monitor for bleeding after the biopsy. You may leave (with your driver) once you are stable, rested for 4 hours and home instructions have been given to you.
The nurse or your planner will review any changes in your medicines. You will be given instructions for getting your blood drawn before you leave.
If more medicine is recommended after the biopsy, it will be sent to your preferred pharmacy before you leave.
Plan quiet activities when you get home. No driving for the rest of the day. Avoid any alcohol use, as always.
You may remove the bandaid from the site the next morning and take a shower. You may notice that the site is bruised or tender.
You should not do any heavy lifting (greater than 10 pounds – about a full gallon of milk) or other strenuous activity for 3 days after the biopsy.
When to Call
Please call if you have sharp abdominal pain, feel dizzy or have a fever greater than 100° F.
Monday-Friday 8:00 a.m. - 5:00 p.m.
Nights and Weekends
Ask for the Transplant Coordinator on call. Give the paging operator your name and phone number with the area code. The Transplant Coordinator will call you back. Tell the Transplant Coordinator you had a liver biopsy and what problems you are having.
If you live out of the area call:
1-800-323-8942. Ask for the Transplant Clinic.