Dynamic Elastography in Diagnostics of Liver Fibrosis in Patients After Liver Transplantation Due to Cirrhosis in the Course of Hepatitis C

Mikołajczyk-Korniak, N.; Tronina, Olga; Ślubowska, K.; Perkowska‐Ptasińska, Agnieszka; Pacholczyk, Marek; Bączkowska, Teresa; Durlik, M.

doi:10.1016/j.transproceed.2016.01.081

Cited by 7 publications

(4 citation statements)

References 15 publications

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“…Compared to other studies, the cut-off value established for TE in this study was relatively low, since other results have ranged from 4.7 to 12.3 kPa ( 20 , 29 – 31 ). In this study, the cut-off values at 1.29 m/s and 7.5 kPa for advanced fibrosis according to LAFSc (and 1.29 m/s and 6.9 kPa for advanced fibrosis according to Ishak score) showed excellent negative predictive values, so that ruling out significant graft fibrosis using LSMs can be deemed considerably safe ( Tables 3 , 4 ).…”

Section: Discussioncontrasting

confidence: 59%

Prospective comparison of liver stiffness measurement methods in surveillance biopsies after liver transplantation

Bosselmann,

Engel,

Hartleben

et al. 2023

Front. Transplant.

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BackgroundLiver stiffness measurements (LSMs) have proven useful for non-invasive detection of fibrosis. Previous studies of LSMs after transplantation were performed in cohorts dominated by hepatitis C reinfections and indication biopsies for the evaluation of graft dysfunction. However, the diagnostic fidelity of LSMs for fibrosis is biased by inflammation e.g., during replicative hepatitis C or rejection.Materials and methodsThe current study aimed for a head-to-head comparison of two different LSMs, acoustic radiation force impulse (ARFI) and transient elastography (TE), and a determination of cut-off values for the detection of advanced fibrosis (any LAF score component ≥2) in grafts undergoing surveillance biopsies (svLbx) without recurrent hepatitis C.Results103 svLbx were paired with valid LSMs at time of biopsy. AUROC analyses showed significant positive correlation with fibrosis for both methods (TE: AUROC = 0.819 (p < 0.001; 95%CI: 0.717–0.921); ARFI: AUROC = 0.771 (p = 0.001; 95%CI: 0.652–0.890). Patients were randomly assigned to training and validation cohorts for both LSM methods. Cut-off values were determined at 1.29 m/s (ARFI) and at 7.5 kPa (TE) in training cohorts. Sensitivity and specificity in training and validation cohorts were: TE: SEN 0.818 and 0.5; SPE 0.742 and 0.885; ARFI: SEN 0.818 and 1.0; SPE 0.75 and 0.586. LSMs were not associated with BANFF criteria for relevant graft injury.ConclusionLSM is a good non-invasive tool to screen for advanced graft fibrosis but not for relevant graft injury in patients with (near) normal liver enzymes. Fibrosis cut-off values identified and validated in svLbx were lower than in previous cohorts using indication biopsies.

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Section: Discussioncontrasting

confidence: 59%

Prospective comparison of liver stiffness measurement methods in surveillance biopsies after liver transplantation

Bosselmann,

Engel,

Hartleben

et al. 2023

Front. Transplant.

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“…In total, 25 articles were included in the final review, with a cumulative sample size of 1829 patients. Of these, 14 articles originated from Europe, (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) 6 articles from North America, (2,(34)(35)(36)(37)(38) 3 from Asia, (39)(40)(41) 1 from South America, (42) and 1 from the Middle East region. (43) Supporting Information 2 describes the baseline characteristics of the included articles.…”

Section: Summary Of Included Articlesmentioning

confidence: 99%

“…The time to assessment of liver fibrosis from LT was 51.60 months. The METAVIR scoring system was the most common definition for fibrosis in 17 studies, (2,(20)(21)(22)(23)(24)28,31,34,(36)(37)(38)(39)(41)(42)(43)(44) followed by 5 studies using the Scheur scoring system, (25,27,29,30,40) 2 studies using the Batts-Ludwig system, (26,33) and 1 study using the Ishak fibrosis score. (32) In the QUADAS-2 assessment of the included articles, a majority of the articles were determined to have low risk of bias.…”

Section: Summary Of Included Articlesmentioning

confidence: 99%

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

Tan

Lim

et al. 2021

Liver Transpl

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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.

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“…10,11,15,16 Because of significant anatomic alterations and higher prevalence of metabolic syndrome and its components, the findings from the non-LT population are not readily translatable to the LT population. 3,17 Although studies evaluating VCTE in LT patients have been performed, they are limited by relatively smaller sample size, [18][19][20] short follow-up after LT, 18,21,22 histologic correlation, 21 and lack of information regarding failed or inaccurate examinations. 18,19,22,23 Furthermore, diagnostic performance of CAP to assess hepatic steatosis has not yet been assessed and the studies evaluating VCTE in LT patients were performed with the M probe without the FibroScan 502 Touch software.…”

mentioning

confidence: 99%

Diagnostic Performance of Vibration-Controlled Transient Elastography in Liver Transplant Recipients

Siddiqui

Idowu

Stromberg

et al. 2021

Clinical Gastroenterology and Hepatology

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BACKGROUND & AIMS:Vibration-controlled transient elastography (VCTE) is a non-invasive tool for detecting hepatic steatosis and fibrosis in patients who have not received liver transplants. We aimed to evaluate the diagnostic performance of VCTE in detection of hepatic steatosis and fibrosis in patients who have undergone liver transplantation. METHODS:We performed a prospective study of 99 liver transplant recipients assessed by VCTE using a standard protocol. Controlled attenuation parameter cutoff values for pairwise steatosis grade and liver stiffness measurements (LSM) and cutoff values for pairwise fibrosis stage were determined using cross-validated area under the receiver operating characteristics (AUROC) curve analyses. We calculated sensitivity (fixed at 90%) and specificity (fixed at 90%) values. RESULTS:A controlled attenuation parameter cutoff value of 270 dB/m detected any hepatic steatosis with an AUROC of 0.88 (95% CI, 0.78-0.93). VCTE detected steatosis grades 2-3 vs 0-1 with an AUROC of 0.94 (95% CI, 0.89-0.99) and steatosis grade 3 vs 0-2 was similar and AUROC of 0.89 (95% CI, 0.83-0.96). When we used an LSM cutoff value of 10.5 kPa, VCTE identified patients with advanced fibrosis (fibrosis stages ‡ 3) with an AUROC of 0.94 (95% CI, 0.88-0.99). At fixed sensitivity, the cutoff LSM value of 10.5k Pa excluded advanced fibrosis with a negative predictive value of 0.99. At fixed specificity, the cutoff LSM value of 16.9 kPa detected advanced fibrosis with a sensitivity of 0.86, a positive predictive value (PPV) of 0.40, and a negative predictive value of 0.99. CONCLUSIONS:VCTE accurately detects hepatic steatosis and fibrosis in recipients of liver transplants. This non-invasive method might be used to identify patients in need of confirmatory liver biopsy analysis.

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Dynamic Elastography in Diagnostics of Liver Fibrosis in Patients After Liver Transplantation Due to Cirrhosis in the Course of Hepatitis C

Cited by 7 publications

References 15 publications

Prospective comparison of liver stiffness measurement methods in surveillance biopsies after liver transplantation

Prospective comparison of liver stiffness measurement methods in surveillance biopsies after liver transplantation

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

Diagnostic Performance of Vibration-Controlled Transient Elastography in Liver Transplant Recipients

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