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Viral Hepatitis

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FAQ: Is there a reason to have a liver biopsy done more than once?

for Veterans and the Public

Frequently Asked Questions

Q: Is there a reason to have a liver biopsy done more than once?

Doctors perform liver biopsies to evaluate how much the hepatitis C virus has affected the liver: very little, moderately, or severely. Liver damage from hepatitis C usually takes many years to develop, and it is not felt by the patient. Long-term damage to the liver can lead to scarring, and when the scarring becomes severe, this is called cirrhosis. Many patients have a liver biopsy to better understand the status of their liver and to help them decide whether to get treatment.

A biopsy generally determines the degree of liver inflammation (called the "grade") and the degree of liver scarring (the "stage"). Both the grade and the stage are given a score from 0 to 4. However, the stage is the most important factor--someone with a "stage 4 biopsy" is said to have cirrhosis.

On average, there is an increase of 1 point in the stage score about every 5-10 years. How often someone should get a liver biopsy depends on the particular patient.

You may want a repeat liver biopsy if:

  • It has been 5 years or more since your last liver biopsy.

Especially if:

  • Your earlier biopsy or biopsies found your stage to be 0 to 3 (not 4) and you want to know whether your liver disease has progressed.

Or if:

  • You are thinking of starting treatment (or re-treatment) because your most recent liver biopsy showed an increase in liver damage compared with a previous biopsy.

You should not need a repeat liver biopsy if:

  • You already know you have cirrhosis.
  • You have a high risk of complications with liver biopsy, such as a very low platelet count or a history of the blood-clotting disorder hemophilia.
  • You already have been treated for hepatitis C and achieved a sustained response. This means no virus was present in your blood 6 months after you stopped taking the medications. Usually, no further liver damage will occur.