Liver Stiffness 1 Year After Transplantation Predicts Clinical Outcomes in Patients With Recurrent Hepatitis C

Abstract

The value of transient elastography (TE) to assess clinical outcomes in hepatitis C recurrence after liver transplantation (LT) has not been explored so far. We studied 144 hepatitis C-infected and 48 non-hepatitis C virus (HCV)-infected LT recipients and evaluated the prognostic value of TE 1 year after transplantation to predict clinical decompensations and graft and patient survival. In HCV patients, cumulative probabilities of liver decompensation 5 years after LT were 8% for patients with liver stiffness measurement (LSM) <8.7 kilopascals (kPa) versus 47% for patients with LSM ! 8.7 kPa (p < 0.001). Five-year graft and patient cumulative survival were 90% and 92% in patients with LSM < 8.7 kPa (p < 0.001) and 63% and 64% in patients with LSM ! 8.7 kPa, respectively (p < 0.001). Patients with low LSM 1 year after LT had excellent outcomes independently from receiving antiviral treatment or achieving sustained virological response (SVR). In contrast, graft survival significantly improved in patients with LSM ! 8.7 kPa who achieved SVR. No association between outcomes and LSM at 12 months was observed in non-HCV patients. In conclusion, LSM 1 year after LT is a valuable tool to predict hepatitis C-related outcomes in recurrent hepatitis C and can be used in clinical practice to identify the best candidates for antiviral therapy.

Serum fibrosis biomarkers predict death and graft loss in liver transplantation recipients

“…To our knowledge, this is the first study to establish the prognostic value of simple fibrosis biomarkers in a large cohort of LT recipients over a long-term follow-up period. Our findings align with those of Crespo et al, 8 who showed that a validated noninvasive fibrosis tool, transient elastography, predicted 5-year clinical outcomes following LT in patients with recurrent HCV. In contrast to their study, we employed simple serum fibrosis biomarkers that are easily implementable and repeatable at regular intervals in busy clinical settings, whereas elastography is available at few centers.…”

“…This time point was chosen based on previous evidence from the literature: (1) the majority of patients (close to 90%) have normalization of their platelets by 1 year after LT, 24 thus the value of biomarkers should be reflective of fibrosis more than resolution of portal hypertension or acute changes occurring in the immediate posttransplant period; (2) in a significant proportion of recipients, recurrent disease (due to HCV or NAFLD/nonalcoholic steatohepatitis [NASH], for example) develop within the first year from LT 8,25 ; and (3) the only study evaluating the prognostic value of a noninvasive fibrosis method demonstrated that transient elastography measured at 1 year after LT predicts outcomes in HCV. 8 Clinical parameters included age, sex, ethnicity, body mass index (BMI), history of diabetes, hypertension or dyslipidemia, primary indication for LT, Model for End-Stage Liver Disease (MELD) score at LT, cold ischemia time, and immunosuppression used after LT (cyclosporine, tacrolimus, or sirolimus). Obesity was defined as BMI > 30 kg/m 2 .…”

“…3,4 Various other factors, such as recipient age, donor age, type of immunosuppression, and cytomegalovirus (CMV) viremia, increase the risk of recurrent fibrosis after LT. 5 The advent of hepatic fibrosis in LT recipients is clinically significant, given that it portends worse longterm survival and need for retransplantation. [6][7][8] The recurrence of chronic liver disease following LT can lead to graft failure, particularly in the case of recurrent HCV. 9 Staging of liver fibrosis is pivotal for prognosis and clinical management in all chronic liver diseases, in both the pretransplant and posttransplant settings.…”

“…11,12 Noninvasive tools have been proposed to stage liver fibrosis, including serum biomarkers based on readily available parameters, such as fibrosis score 4 (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), NAFLD fibrosis score, and measurement of liver stiffness by transient elastography (FibroScan). 8,13,14 These noninvasive methods have shown good accuracy in detecting advanced liver fibrosis and cirrhosis, thus rendering repeat assessment of fibrosis feasible over time. Moreover, these noninvasive tools have meaningful prognostic utility in identifying patients at high risk for liver-related complications, death, and need for LT in chronic viral hepatitis and NAFLD.…”

“…[16][17][18][19][20][21][22] One report thus far has suggested the prognostic value of a noninvasive fibrosis tool in the posttransplant setting. In this study, transient elastography has been shown to predict 5-year outcomes in patients with recurrent HCV following LT. 8 However, elastography is not widely available at this time and often cannot be performed at regular intervals. Early identification of patients at risk for worse prognosis is of paramount importance for risk stratification and optimization of health care resources.…”