FibroScan Evaluation of Liver Fibrosis in Liver Transplantation

Antolín, Gloria Sánchez; Pajares, Félix García; Vallecillo, M. A.; Orcajo, P. Fernandez; Cuesta, Sara Gómez de la; Alcaide, No.; Sagrado, M. González; Velicia, R.; Caro-Patón, A.

doi:10.1016/j.transproceed.2009.02.027

Cited by 24 publications

(19 citation statements)

References 7 publications

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“…Increased failure rates in obese patients described in the literature are consistent with our results. Our patients were in the 90th percentile or lower of BMI for age as recommended, thus preventing measurement failure due to obesity . We did not do TE in patients with skin to liver capsule distance above 25 mm .…”

Section: Methodsmentioning

confidence: 99%

“…TE uses the formula E = 3 p V s 2 , which is based on Hooke's law, where E is Young's modulus, p is mass density (assumed to be 1000 kg/m 3 ), and V s is the velocity of the shear wave . TE has already been validated in adults with chronic hepatitis and NAFLD, and its results have been shown to significantly correlate with the histological staging of liver fibrosis . TE measures liver stiffness in a tissue volume that approximates a cylinder with a diameter of 1 cm and a length of 4 cm, which is sampled under the skin surface between 15 and 65 mm, depending on the probe used (S1, S2, or M).…”

Section: Introductionmentioning

confidence: 99%

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Transient elastography for non‐invasive evaluation of post‐transplant liver graft fibrosis in children

Vinciguerra

Brunati

David

et al. 2018

Pediatric Transplantation

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As graft survival in pediatric LT is often affected by progressive fibrosis, numerous centers carry out protocol liver biopsies. Follow-up biopsy protocols differ from center to center, but all biopsies are progressively spaced out, as time from transplant increases. Therefore, there is a need for non-invasive techniques to evaluate graft fibrosis progression in those children who have no clinical or serological signs of liver damage. Indirect markers, such as the APRI, should be relied on with caution because their sensitivity in predicting fibrosis can be strongly influenced by the etiology of liver disease, severity of fibrosis, and patient age. A valid alternative could be TE, a non-invasive technique already validated in adults, which estimates the stiffness of the cylindrical volume of liver tissue, 100-fold the size of a standard needle biopsy sample. The aims of this study were to evaluate the reliability of TE in children after LT and to compare both the TE and the APRI index results with the histological scores of fibrosis on liver biopsies. A total of 36 pediatric LT recipients were studied. All patients underwent both TE and biopsy within a year (median interval -0.012 months) at an interval from LT of 0.36 to 19.47 years (median 3.02 years). Fibrosis was assessed on the biopsy specimens at histology and staged according to METAVIR. There was a statistically significant correlation between TE stiffness values and METAVIR scores (P = .005). The diagnostic accuracy of TE for the diagnosis of significant fibrosis (F ≥ 2) was measured as the area under the curve (AUROC = 0.865), and it demonstrated that the method had a good diagnostic performance. APRI was not so accurate in assessing graft fibrosis when compared to METAVIR (AUROC = 0.592). A liver stiffness cutoff value of 5.6 kPa at TE was identified as the best predictor for a significant graft fibrosis (METAVIR F ≥ 2) on liver biopsy, with a 75% sensitivity, a 95.8% specificity, a 90% positive predictive value, and an 88.5% negative predictive value. These data suggest that TE may represent a non-invasive, reliable tool for the assessment of graft fibrosis in the follow-up of LT children, alerting the clinicians to the indication for a liver biopsy, with the aim of reducing the number of protocol liver biopsies.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transient elastography for non‐invasive evaluation of post‐transplant liver graft fibrosis in children

Vinciguerra

Brunati

David

et al. 2018

Pediatric Transplantation

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“…TE uses the propagation velocity of a pressure‐induced shear wave to calculate liver stiffness. Its results have been shown to correlate well with fibrosis score on liver histology in various liver diseases in adults . The technique is generally applicable in children and has been shown to be of some diagnostic value in children with biliary atresia, cystic fibrosis, autoimmune liver disease, and NASH/NAFLD .…”

mentioning

confidence: 85%

The use of transient elastography and non‐invasive serum markers of fibrosis in pediatric liver transplant recipients

Goldschmidt

Stieghorst

Munteanu

et al. 2013

Pediatric Transplantation

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The use of non-invasive markers to diagnose liver allograft fibrosis is not well established in children after LTx. TE, FT, and ELF score were performed in 117 liver-transplanted children (60M, 8.9 [0.5-18.5] yr) and 336 healthy controls. Liver biopsy was available in 36 children. Results of histology and non-invasive markers were compared using correlation coefficient or Mann-Whitney U-test as appropriate. TE correlated best with histological degree of fibrosis (r = 0.85 vs. r = 0.04 [FT] or r = -0.38 [ELF]). Liver stiffness values for transplanted children without fibrosis were significantly higher than those of healthy controls (7.55 [5.4-20.4] kPa vs. 4.5 [2.5-8.9] kPa). Presence of rejection was a potent confounder for the performance of TE. Both TE and FT reflected clinical changes (acute rejection, cholestasis, increasing fibrosis) in a total of 16 patients who underwent serial measurements. TE correlates better with histological degree of fibrosis in liver-transplanted children than FT or ELF, but an individual baseline value needs to be determined for each patient. Normal or cutoff values for pathological degrees of fibrosis cannot be transferred from non-transplanted children. Follow-up studies, preferably with protocol biopsies, might help to improve the diagnostic quality of TE.

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“…The failure rate of the measurements is of around 6% with, as essential limitation, the obesity of the patient which impedes the progression of the ultrasounds (7). A BMI >28 kg/m 2 increases the failure rate of the LS measurements using the FibroScan ® (8). Age does not alter LS, therefore, permitting the use of the FibroScan ® in the assessment of liver grafts in elderly donors (9).…”

Section: Materiel and Methodsmentioning

confidence: 99%

Value of liver stiffness measured by transient elastography in the liver transplant pre‐operative evaluation of the potential deceased liver donors: preliminary study

Pichon

Loustaud‐Ratti²,

Clavel

et al. 2010

Clinical Transplantation

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The selection of a liver graft is crucial for the success of a transplantation. One of the determinant factors in the selection of a liver graft of quality is to assess the degree of steatosis. The aim of this study was to evaluate the feasibility of a FibroScan(®) during the liver retrieval procedure and to determine the interest of measuring liver stiffness (LS) using the FibroScan(®) as a criterion of objective assessment in the pre-donation selection of liver grafts. Of 16 FibroScan(®) performed on 16 livers of donors meeting conventional French criteria for the selection of liver grafts, the LS values were considered as abnormal in three donors (18.75%). The correspondence with the histologic analysis of the biopsies in terms of elevated steatosis was excellent. For 13 other liver grafts, the values of LS were normal as were the histologic analyses of the biopsies. A supplementary multicenter study is required in order to position the transient elastography as the objective examination in the pre-operative selection of liver grafts.

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FibroScan Evaluation of Liver Fibrosis in Liver Transplantation

Cited by 24 publications

References 7 publications

Transient elastography for non‐invasive evaluation of post‐transplant liver graft fibrosis in children

Transient elastography for non‐invasive evaluation of post‐transplant liver graft fibrosis in children

The use of transient elastography and non‐invasive serum markers of fibrosis in pediatric liver transplant recipients

Value of liver stiffness measured by transient elastography in the liver transplant pre‐operative evaluation of the potential deceased liver donors: preliminary study

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