A Diagnostic Test Meta‐Analysis Evaluating Imaging‐Based and Blood Biomarker–Based Assessment Tools for Fibrosis After Liver Transplantation

Abstract

Early detection of liver graft fibrosis is crucial for risk stratification to identify patients for liver biopsy and timely treatment. However, diagnostic accuracy of noninvasive tests (NITs) remains unclear. Thus, this study sought to evaluate diagnostic accuracy of NITs in assessing liver allograft fibrosis and compare the differences in specificities and sensitivities among NITs. Medline and Embase databases were searched to include articles on diagnostic tests in liver transplantation (LT) patients with fibrosis. A meta‐analysis on diagnostic test accuracy was conducted in a random‐effects model. Sensitivities and specificities among the diagnostic tests were compared, and threshold values were calculated where applicable. A total of 25 articles were included. Vibration‐controlled transient elastography (VCTE) met the minimum diagnostic accuracy requirements, yielding sensitivity, specificity, and diagnostic odds ratios of 0.9 (CI, 0.8‐1.0), 0.9 (CI, 0.8‐1.0), and 379.6 (CI, 45.8‐1728.7), respectively. In the threshold assessment, the optimal cutoff was 9.30 kPa with a sensitivity, specificity, and area under the curve of 0.7 (CI, 0.5‐0.9), 0.9 (CI, 0.8‐0.9), and 0.9 (CI, 0.8‐0.9), respectively. For significant fibrosis, acoustic radiation force impulse (ARFI) was superior to FibroTest (LabCorp [Burlington, NC]) and magnetic resonance elastography (MRE) in sensitivity. VCTE was superior to FibroTest in specificity. For advanced fibrosis, ARFI was superior to the Fibrosis‐4 Index (FIB‐4) in sensitivity. VCTE was superior to the AST to Platelet Ratio Index (APRI), MRE, and FIB‐4 in specificity. In cirrhosis, VCTE was superior to APRI in specificity (P = 0.004) with comparable sensitivity. This study demonstrates the potential of VCTE and ARFI as diagnostic tools for fibrosis in LT recipients compared with blood‐based NITs, which were shown to be less optimal.

Evaluation of liver stiffness measurement–based scores in liver transplantation recipients

“…This study confirms that noninvasive testing can be used in LT recipients to identify at‐risk patients 9,11,15. Moreover, the use of CPMs can lead to further refinement of noninvasive strategies.…”

Non-alcoholic fatty liver disease increases risk of carotid atherosclerosis and ischemic stroke: An updated meta-analysis with 135,602 individuals

“…An analysis of proportions was pooled using a generalized linear mixed model with Clopper-Pearson intervals [ 27 , 28 ]. To assess risk factors, a generalized mix model with a logit link and inverse variance weightage were used to derived the odds ratio (OR) [ 29 ]. Bivariate analysis of dichotomous variables was analysed in Paul Mantel ORs with and mean difference (MD) with inverse variance for continuous variables.…”

Prediction of long‐term morbidity and mortality after liver transplantation using two‐dimensional shear wave elastography compared with liver biopsy

“…[ 27 ] Liver biopsy is the reference standard to assess graft damage in the LT population. [ 14 ] Although recently decreasing, frequent liver biopsies have been part of the routine LT follow‐up in some centers. [ 16 ] The presence of fibrosis within 1 year of LT is associated with a high possibility of graft loss.…”

“…Among the available techniques for noninvasive fibrosis assessment, transient elastography has been the most widely studied and available. [ 14 ] Our study is unique as it involved the use of 2D‐SWE in post‐LT patients.…”

“…Identifying easy-touse, noninvasive surrogates of fibrosis or disease severity may be helpful. A recent meta-analysis highlights the potential of noninvasive tools such as elastography in diagnosis of fibrosis after LT. [14] Two-dimensional shear wave elastography (2D-SWE) is a rapid, noninvasive method of liver stiffness measurement (LSM) through the evaluation of the physical properties of the liver parenchyma. [15] The measured LSM by 2D-SWE and transient elastography correlates with the presence of histological fibrosis, [15][16][17][18] and elevated LSM is associated with the development of liver-related complications and mortality.…”