What it Was Like to Have a Liver Biopsy

At one year post liver transplant, you will probably be required to have a liver biopsy, or you may be having one as a diagnostic test to confirm liver disease. I had one at the one-year milestone.

My biopsy was distressing

My transplant had been followed by a one-month hospitalization for COVID. I was probably still traumatized by my experience with medical procedures, but I found the liver biopsy to be distressing. It is like any other medical procedure in that you are in a hospital gown, cold, unsure of what will happen and feeling very vulnerable. These experiences are heavily influenced by the attitudes and caring (or lack of it) from the healthcare workers providing the service.

The needle was large

They gave me a local anesthetic by injection in my abdomen. That local felt like any other injection. It hurts but it is tolerable. On the other hand, the biopsy needle that is used is very large. I did not feel that large needle when it went through my skin, but I felt it when it popped into my liver. It hurt a bit, but it is likely that my distress colored my experience of the liver biopsy. Compared to what you have already been through this procedure may not be a big deal. I did not enjoy it at all, but while invasive it is not overly painful.

Confusing results

When I got the results back it confirmed that I had steototic (fatty) liver disease in my new liver! A resident called to deliver the results and read them off to me. This is what she said, “you have recurrent steatohepatitis, with 40% mixed steatosis, you have mild periportal fibrosis, fibrosis stage 2 out of four, you have an RAI of two out of nine, and you have mild activity or an NAS score of five out of eight." She told me that I had fat in my liver and needed to “Be careful." She did not explain what that meant.

I researched everything

I found out that 34 to 64% steatosis is considered moderate.¹ Stage 2 liver fibrosis (or liver scarring) is caused by chronic inflammation. Scarred tissue begins to replace healthy tissue, which reduces how well your liver functions. Liver scar tissue also reduces blood flow to your liver. RAI stands for rejection activity index and a score of 0 to 2 is no rejection. So, I had no rejection.

The NAS is the activity score and ranges from zero to eight points. A score of five or higher indicates NASH and less than 3 is unlikely to be NASH. To me, this meant I had NASH again. I made an appointment with a gastroenterologist to explain the results to me. She told me that I do not have NASH, but I do have what is now called MASLD.

It is important to realize that the accuracy of liver biopsies is questionable. There may be bias or sampling errors that skew the results.² The interpretation of a liver biopsy relies on human assessment and there is evidence that interpretation is different depending on the person reading it. Sometimes the part of the liver that is collected may not be representative of the entire liver.

My advice to you

It was not the best experience for me, but it may not be a problem for you. Make sure that the technicians explain everything and that you keep calm and still during the procedure. It gives your physician a lot of information they need to know about what is happening with your liver. When you get your results, insist that someone explain them to you in a way you can understand, and explain what you should be doing to manage whatever level of disease exists, if any. Some people do not get MASLD or MASH in their transplanted liver.