Late allograft fibrosis in pediatric liver transplant recipients: Assessed by histology and transient elastography

Abstract

Late allograft fibrosis in LT recipients can cause graft dysfunction and may result in re‐transplantation. TE is a non‐invasive tool for the assessment of liver fibrosis. We aimed to evaluate the prevalence of allograft fibrosis in pediatric LT recipients, identify factors associated with allograft fibrosis, and determine the diagnostic value of TE, compared to histology. All children who underwent LT for ≥3 years were included. TE was performed for LSM in all patients. LSM of ≥7.5 kPa was considered as abnormal and suggestive of allograft fibrosis. Percutaneous liver biopsy was performed when patients had abnormal LSM and/or abnormal LFTs. Histological fibrosis was diagnosed when METAVIR score ≥F1 or LAF scores ≥1. TE was performed in 43 patients and 14 (32.5%) had abnormal LSM suggestive of allograft fibrosis. Histological fibrosis was identified in 10 of the 15 patients (66.7%) who underwent percutaneous liver biopsy and associated findings included chronic active HBV infection (n = 3), and late acute rejection (n = 3). Multivariate analysis showed that graft age was significantly associated with allograft fibrosis (OR = 1.22, 95% CI: 1.05‐1.41, P = 0.01). In conclusion, late allograft fibrosis is common in children undergoing LT for ≥3 years and associated with graft age. HBV infection and late acute rejection are common associated findings. Abnormal TE and/or LFTs may guide physicians to consider liver biopsy for the detection of late allograft fibrosis in LT children.

Detection of graft fibrosis by vibration‐controlled transient elastography in pediatric liver transplant recipients

“…Although clinical application of these laboratory parameters is limited, as fibrosis of the graft can occur with completely normal laboratory indicators, it is possible that these routinely obtained values may suggest those patients in need of further evaluation with LSM. Time from transplant, history of ACR, history of rejection, or type of immunosuppressant medication had no correlations with LSM, which is different from previously published data 20 . While these factors may affect liver fibrosis and LSM, we likely did not find a statistical significance due to our small sample size.…”

“…These results support and add to previously published data also showing a correlation between liver stiffness and hepatic fibrosis 13,14 . Our data conflict with a recent study which showed only a 66.7% accuracy of LSM in predicting fibrosis 20 . We were also able to provide a cutoff value of 7.25 kPa that is helpful in predicting significant graft fibrosis.…”

Transient elastography assessment of liver allograft fibrosis in pediatric transplant recipients

“…TE is an ultrasound-based method that measures liver stiffness, which has been shown to correlate with the histological degree of been reported only in a few small studies (4). 15,[19][20][21] The first study published in 2013 showed that TE performed In our cohort, neither APRI nor FIB-4 appeared to be useful in discriminating between patients with F0/F1 and F2-F4 fibrosis.…”

“…Its use in children who have received LT has been reported in only a few small studies. 15,[19][20][21] The aim of this study was to evaluate the ability of TE to predict clinically significant, histologically assessed liver graft fibrosis (METAVIR F2-F4) in a large cohort of pediatric and young adult LT recipients at a single transplant center. Secondary aims were (a) to compare the predictive ability of TE to that of the APRI and the FIB-4, and (b) to investigate whether or not graft type had any effect on the performance of LSMs.…”

“…as part of MV. At LSM, median ALT was 25 [IQR [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]] IU/L. Twenty-one percent had METAVIR ≥ F2.…”