Shear-wave elastography for the assessment of liver fibrosis in liver transplant recipients treated for hepatitis C virus recurrence

Korda, Dávid; Lenard, Zsuzsanna M.; Gerlei, Zsuzsanna; Jakab, Zsuzsanna; Haboub-Sandil, Anita; Wagner, László; Varga, Marina; Cseprekál, Orsolya; Márton, Adrienn; Horváthy, Dénes B.; Takács, Szabolcs; Doros, Attila; Máthé, Z.

doi:10.1097/meg.0000000000001003

Cited by 18 publications

(8 citation statements)

References 40 publications

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“…The same was true for APRI and FIB-4 indexes that showed significant improvement at 24 and 48 weeks after therapy. Similar to our results, another recently published article [30] that evaluated 23 LT patients with recurrent HC treated for 24 weeks with OBV/PTV/r+DSV±RBV combination therapy, showed that shear-wave elastography and also APRI and FIB-4 were successfully used to monitor the beneficial therapeutic effects of DAAs in hepatitis C recurrence following LT. Mauro et al [31] proved that 67% of the cohort presented fibrosis regression; HVPG, liver stiffness and ELF score significantly decreased after SVR. There are also few previous studies [32][33] reporting histological and clinical benefits, associated with improvement of patient and graft survival after SVR in LT recipients.…”

Section: Discussionsupporting

confidence: 89%

100% Sustained Virological Response and Fibrosis Improvement in Real-Life Use of Direct Acting Antivirals in Genotype-1b Recurrent Hepatitis C following Liver Transplantation

Iacob

Cerban

Pietrareanu

et al. 2018

JGLD

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Background: Nowadays, interferon-free therapy using new direct-acting antivirals (DAA) has dramatically increased the cure rate across different HCV-infected patient populations, including groups traditionally viewed as difficult-to-treat (patients with co-infections, cirrhosis and liver transplant – LT recipients) with marked improvement in safety and tolerability.Aim: To present our experience with DAA therapy in LT recipients, as well as to compare pre- and posttreatment liver stiffness (LS) and noninvasive fibrosis scores.Methods: Our cohort consisted of 89 patients with genotype 1 (GT1) recurrent hepatitis C after LT.Seventy six patients received ombitasvir/paritaprevir/ritonavir+dasabuvir+ribavirin and 13 sofosbuvir/ ledipasvir±ribavirin. Fibroscan®, FIB4 and APRI scores were performed in all patients before and 12 weeks after DAA therapy.Results: We analyzed 45 (50.5%) males and 44 (49.5%) females with a mean age of 55±7.7 years. Median time since LT was 20.9 months. At baseline, 53 (59.6%) of patients had severe necroinflammation at Fibromax®; advanced fibrosis (F3, F4) was encountered in 35 (39.4%) and grade 3 steatosis in 33 (37.1%) of LT recipients.End of therapy (EOT) virological response (VR) was 100%. Sustained virological response 12 weeks after therapy (SVR12) was 97.7% in the intention-to-treat analysis and 100% in per protocol analysis. There was a significant improvement in LS between antiviral therapy initiation and SVR12: 11.9±1.05kPa vs 8.8±0.6kPa (p<0.0001), as well as in APRI (2.7±0.3 vs 0.4±0.05, p<0.0001) and FIB4 (4.6±0.5 vs 2.5±0.2, p<0.0001) scores.Conclusion: In HCV positive recipients, DAA regimens are highly effective and safe. A significant decrease of LS by transient elastography and fibrosis non-invasive scores can be observed after successful therapy.

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Section: Discussionsupporting

confidence: 89%

100% Sustained Virological Response and Fibrosis Improvement in Real-Life Use of Direct Acting Antivirals in Genotype-1b Recurrent Hepatitis C following Liver Transplantation

Iacob

Cerban

Pietrareanu

et al. 2018

JGLD

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“…In recent years, various SWE techniques are gaining wide acceptance among clinicians as a noninvasive tool for the detection and precise staging of fibrosis and cirrhosis, which are very important for the timely initiation of appropriate therapeutic regimens [14]. Furthermore, the SWE technique could be widely used for monitoring liver fibrosis after the application of antiviral agents [26,27]. Therefore, for the longitudinal assessment or monitoring of liver fibrosis, the interchangeability of LS measurements made using different SWE techniques could be of significant value.…”

Section: Discussionmentioning

confidence: 99%

Reproducibility of liver stiffness measurements made with two different 2-dimensional shear wave elastography systems using the comb-push technique

et al. 2019

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Purpose The purpose of this study was to retrospectively compare the technical success and reliability of the measurements made using two 2-dimensional (2D) shear wave elastography (SWE) systems using the comb-push technique from the same manufacturer and to assess the intersystem reproducibility of the resultant liver stiffness (LS) measurements. Methods Ninety-four patients with suspected chronic liver diseases were included in this retrospective study. LS measurements were obtained using two 2D-SWE systems (LOGIQ E9 and LOGIQ S8) from the same manufacturer, with transient elastography (TE) serving as the reference standard, on the same day. The technical success rates and reliability of the measurements of the two 2D-SWE systems were compared. LS values measured using the two 2D-SWE systems and TE were correlated using Spearman correlation coefficients and 95% Bland-Altman limits of agreement. Thereafter, Bland-Altman limits of agreement and intraclass correlation coefficients (ICCs) were used to analyze the intersystem reproducibility of LS measurements. Results The two 2D-SWE systems showed similar technical success rates (98.9% for both) and reliability of LS measurements (92.3% for the LOGIQ E9, 91.2% for the LOGIQ S8; P=0.185). Despite the excellent correlation (ICC=0.92), the mean LS measurements obtained by the two 2D-SWE systems were significantly different (LOGIQ E9, 6.57±2.33 kPa; LOGIQ S8, 6.90±6.64 kPa; P=0.018). Conclusion Significant intersystem variability was observed in the LS measurements made using the two 2D-SWE systems. Therefore, even 2D-SWE systems from the same manufacturer should not be used interchangeably in longitudinal follow-up.

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“…Moreover, we could acquire liver biopsies from only 9 patients, and only 8 patients had clinically diagnosed cirrhosis. In addition, 4 patients with cirrhosis had been successfully treated for HCV; according to a recent study, the fibrosis stage decreases when HCV treatment eliminates HCV in the patient (Korda et al 2018). Thus, the fibrosis stages of those 4 patients were somewhat unclear.…”

Section: Discussionmentioning

confidence: 99%

Influence of Probe Pressure on Ultrasound-Based Shear Wave Elastography of the Liver Using Comb-Push 2-D Technology

Byenfeldt

Elvin

Fransson

2019

Ultrasound in Medicine & Biology

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It has been postulated that in the liver, applying increased probe pressure during ultrasound-based shear wave elastography (SWE) might lead to a false increase in the SWE result. We aimed to determine the influence of increased intercostal probe pressure when performing SWE of the liver. We also investigated the number of measurements required to achieve technically successful and reliable SWE examinations. This prospective, clinical study included 112 patients and 2240 SWE measurements of the liver. We applied probe pressure intercostally, to reduce the skin-to-liver capsule distance (SCD), which could stabilize the SWE signal and thus increase the number of technically successful measurements. We performed 10 measurements with maximum probe pressure and 10 with normal pressure in each patient. Thus, two analysis groups were compared for differences. Compared with normal pressure, maximum probe pressure significantly reduced the SCD (p < 0.001) and significantly increased the number of technically successful measurements from 981 to 1098, respectively (p < 0.001). The SWE results with normal and maximum probe pressure were 5.96 kPa (interquartile range: 2.41) and 5.45 kPa (interquartile range: 1.96), respectively (p < 0.001). In obese patients, a large SCD poses a diagnostic challenge for ultrasound SWE. We found that maximum intercostal probe pressure could reduce the SCD and increase the number of technically successful measurements, without falsely increasing the SWE result. Only three measurements were required to achieve technically successful and reliable SWE examinations.

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Shear-wave elastography for the assessment of liver fibrosis in liver transplant recipients treated for hepatitis C virus recurrence

Cited by 18 publications

References 40 publications

100% Sustained Virological Response and Fibrosis Improvement in Real-Life Use of Direct Acting Antivirals in Genotype-1b Recurrent Hepatitis C following Liver Transplantation

100% Sustained Virological Response and Fibrosis Improvement in Real-Life Use of Direct Acting Antivirals in Genotype-1b Recurrent Hepatitis C following Liver Transplantation

Reproducibility of liver stiffness measurements made with two different 2-dimensional shear wave elastography systems using the comb-push technique

Influence of Probe Pressure on Ultrasound-Based Shear Wave Elastography of the Liver Using Comb-Push 2-D Technology

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