Diagnostic Accuracy of Transient Elastography for Detecting Liver Fibrosis After Liver Trannsplantation: A Specific Cut-Off Value Is Really Needed?

Della-Guardia, B.; Evangelista, Ana Catarina Jorge; Felga, Guilherme Eduardo Gonçalves; Marins, Lidiane V.; Salvalaggio, Paolo R.; Almeida, Márcio Dias de

doi:10.1007/s10620-016-4349-1

Cited by 14 publications

(9 citation statements)

References 30 publications

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“…14 The data regarding failure rate and unreliable examination in LT population are lacking, particularly with the newer XL probe and automatic selection software. 18,19,21,22 In our cohort, the device software recommended the use of XL probe in nearly a third of our LT recipients.…”

Section: Discussionmentioning

confidence: 93%

“…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%

“…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. Thus, a recently published meta-analysis evaluating the performance characteristics of VCTE in LT recipients was limited by the factors noted in trial designs of the studies listed previously 24 and underscores the importance of systematically evaluating the diagnostic performance of CAP and LSM in LT recipients.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 93%

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confidence: 99%

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confidence: 99%

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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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“…In a large, more recent prospective study of 259 patients evaluated by TE and liver biopsy, the cutoffs proposed for all patients to achieve a specificity of ≥90% were 8.1 kPa for F ≥ 1, 12.3 kPa for F ≥ 2, 15.1 for F ≥ 3, and 16.7 for F = 4. When only patients with HCV were analyzed, the cutoffs were adjusted to 8.1 kPa for F ≥ 1, 12.3 kPa for F ≥ 2, 16.5 for F ≥ 3, and 17.6 for F = 4 to achieve a specificity of ≥90% . Although a large study such as this shows promise, many of the other published studies dedicated to post‐LT TE have been small, single‐center series and have lacked a validation cohort.…”

Section: Methodsmentioning

confidence: 99%

A review of the use of transient elastography in the assessment of fibrosis and steatosis in the post–liver transplant patient

Winters

Mittal

Schiano

2019

Clinical Transplantation

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Liver biopsy is considered the gold standard method for diagnosing and staging liver disease, particularly in the post-liver transplant setting. Given the invasive nature of biopsy, alternate means for accurately assessing liver fibrosis and steatosis are preferred especially as the number of patients with fatty liver disease is increasing.Transient elastography has been validated as a useful tool for evaluation of liver fibrosis, as has controlled attenuation parameter index as a tool for assessing steatosis. It is a non-invasive, rapid, and highly reproducible approach to demonstrate the presence of fibrosis among non-transplant patients with chronic liver disease of various etiologies. However, it has not yet found wide acceptance in liver transplant recipients. There are few published studies evaluating the merits and applicability of transient elastography to assess allografts after liver transplantation. We review the published data on the use of transient elastography with concurrent controlled attenuation parameter in liver transplant recipients and recommend its greater use to follow allograft function over time.

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“…Transient elastography could represent an alternative to liver biopsy for assessing liver fibrosis post-liver transplantation in chronic HCV infected patients. The optimal cut-off value of liver stiffness ranged from 8.1 kPa for liver fibrosis stage ≥ 1 to 17.6 for stage 4 [66].…”

Section: The Follow-up Of Patients With Recurrent Hepatits C After a mentioning

confidence: 99%

Liver stiffness in chronic hepatitis C virus infection

Mihăilă

2019

Romanian Journal of Internal Medicine

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Introduction. The severity of liver fibrosis can be assessed noninvasively today by liver stiffness measurements. Vibration-controlled transient elastography, shear wave elastography or magnetic resonance elastography are techniques increasingly used for this purpose. Methods. This article presents the recent advances in the use of new techniques for liver fibrosis assessment in chronic hepatitis C: the correlation between liver stiffness values and liver fibrosis estimated by liver biopsies, the prognosis role of liver stiffness values, their usefulness in monitoring the treatment response, in assessing the severity of portal hypertension and in estimating the presence of esophageal varices. Scientific articles from January 2017 to January 2018 were searched in PubMed and PubMed Central databases, using the terms “liver stiffness” and “hepatitis C”. Results. The median liver stiffness values measured with different techniques are not identical, so that FibroScan thresholds cannot be used on any other elastographic machine. The higher the liver’s stiffness measurement, the higher the liver-related events in patients with chronic hepatitis C. A liver stiffness measurement over 17 kPa could be an independent predictor for the presence of esophageal varices as well as a spleen with a longitudinal span ≥ 15 cm for patients with a value of liver stiffness < 17 kPa. A progressive and persistent decrease in liver stiffness is dependent on sustained virological response achievement. The lack of liver stiffness decrease has been associated with relapsers and a low value of liver stiffness at baseline. Conclusion. Liver stiffness provides clues about the severity and evolution of liver disease.

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Diagnostic Accuracy of Transient Elastography for Detecting Liver Fibrosis After Liver Trannsplantation: A Specific Cut-Off Value Is Really Needed?

Abstract: TE demonstrated good performance in defining cut-off points for fibrosis on liver histology observed in transplant recipients. The TE can be considered an alternative to LB in post-liver transplantation.

Cited by 14 publications

References 30 publications

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

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

A review of the use of transient elastography in the assessment of fibrosis and steatosis in the post–liver transplant patient

Liver stiffness in chronic hepatitis C virus infection

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