Non-Invasive Assessment of Graft Fibrosis After Living Donor Liver Transplantation: Is There Still a Role for Liver Biopsy?

El-Meteini, Mahmoud; Sakr, Mostafa; Eldorry, Ahmed; Mohran, Z; Abdelkader, Nadia Abdelaaty; Dabbous, Hany; Montasser, Iman Fawzy; Refaie, Rasha; Salah, Maged; Aly, Mohamed

doi:10.1016/j.transproceed.2019.01.197

Cited by 11 publications

(11 citation statements)

References 16 publications

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“…20 A prospective study that compared indirect markers in contrast to liver biopsy for the detection and staging of fibrosis in allografts in patients undergoing living donor LT for HCV-related complications, concluded that there was no statistical correlation between the results obtained for stiffness and liver biopsy, and TE should not be recommended as an alternative technique in this situation. 18 Also similar to our data, Barrault et al observed a significant difference between stages F0/F1 and F2 versus F3/F4 in the diagnostic value of liver stiffness. Nevertheless, they concluded that the performance of TE is able to accurately identify LT recipients with significant fibrosis.…”

Section: Discussionsupporting

confidence: 92%

“…16 Recurrence of HCV after LT is frequent and deposition of fibrosis is accelerated in these cases and may be responsible for development of graft cirrhosis in up to 30% of patients five years after the procedure. 1,3,17,18 The deposition of collagen fibers in liver tissue is the main determinant of long-term graft survival; for this reason, surveillance programs for fibrosis staging and early identification of HCC are extremely important to intervene in the therapeutic management of this population.…”

Section: Discussionmentioning

confidence: 99%

“…Performing a liver biopsy after LT is a tool employed as part of protocols in many clinical centers; however, it is subject to limitations such as the associated risk of morbidity, including the possibility of bleeding and perfusion, increased financial costs, and both intraobserver and interobserver disagreement in interpretation. 2,10,18 These considerations are important, given the need for longitudinal follow-up of recurrent fibrosis. These limitations led to the development of noninvasive methods that have gained popularity in current clinical practice.…”

Section: Discussionmentioning

confidence: 99%

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Transient Hepatic Elastography in the Assessment of Liver Fibrosis in Patients After Liver Transplantation

Longo¹,

Matheus²,

Santos³

et al. 2021

Acta gastroenterol. latinoam.

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Introduction and Objectives. Liver biopsy is the gold standard for assessing fibrosis and inflammation in liver transplant recipients. As this study has risks, the use of noninvasive tools has been proposed, including transient elastography, a method that needs further study in this population, which is the purpose of this research. Material and methods. Demographic and clinical data were collected retrospectively in patients who received a liver transplant, underwent liver biopsy and transient elastography less than 1 year apart. Sensitivity, specificity, diagnostic accuracy and Kappa concordance test between the two methods were determined. Results. Of 356 patients evaluated after transplantation, 45 underwent liver biopsy and transient elastography within 1 year; 60.0% were male and 75.6% had hepatitis C virus infection. At the time of transient elastography, laboratory values were: mean total bilirubin 1.5 mg/dL, alanine aminotransferase 108.1 U/L, aspartate aminotransferase, 101.6 U/L, alkaline phosphatase, 96.0 U/L and gamma-glutamyl transferase 9.0 U/L. The main indications for liver biopsy were assessment for rejection, hepatitis C virus infection or both. According to liver biopsy, 82.2% presented absent or minimal fibrosis and 75.6% had no inflammation. Acute cellular rejection was present in 20.0% of cases. A cut-off point of > 9.5 kPa was used to define advanced fibrosis, while a value < 7.5 kPa was set to indicate absent or mild fibrosis. Poor agreement was found between transient elastography and liver biopsy for these categories (Kappa 0.125, sensitivity 69.5%, specificity 66.7%) and for specific stages of fibrosis (Kappa 0.095). Conclusions. Accuracy, sensitivity and specificity were low for fibrosis staging when comparing transient elastography with liver biopsy. In liver transplant recipients, transient elastography would overestimate fibrosis, probably due to inflammation secondary to other causes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Transient Hepatic Elastography in the Assessment of Liver Fibrosis in Patients After Liver Transplantation

Longo¹,

Matheus²,

Santos³

et al. 2021

Acta gastroenterol. latinoam.

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“…In a separate study of liver transplant recipients with hepatitis C recurrence, MRE demonstrated similar diagnostic accuracy. MRE demonstrated an AUROC of 0.7 in the detection of fibrosis greater than Metavir stage 2 with significant correlation to fibrosis stage in one cohort of 31 patients [51]. In another study, the diagnostic accuracy was slightly superior with an AUROC of 0.87.…”

Section: Mr Elastography Of Liver Graftmentioning

confidence: 83%

Elastography in the evaluation of liver allograft

et al. 2020

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Elastography is an established technique in the evaluation of chronic liver diseases. While there is a large clinical experience and data available regarding the performance of elastography in native liver, elastography experience with liver grafts is limited and still growing. Both ultrasound-based elastography techniques and MR Elastography (MRE) are useful in the assessment of liver fibrosis in liver transplants. Technical modifications for performing elastography will be required for optimum evaluation of the graft. In general, caution needs to be exercised regarding the use of elastography immediately following transplantation as post-operative changes, perioperative conditions/complications, inflammation, and rejection can cause increased stiffness in the graft. In the follow-up, detection of increased stiffness with elastography is useful for predicting development of fibrosis in the graft. Adjunctive MRI or ultrasound with Doppler also provides comprehensive evaluation of anatomy, vascular anastomosis and patency, biliary tree, and stiffness for fibrosis. In this review, we provide a brief overview of elastography techniques available followed by the literature review of elastography in the evaluation of grafts and illustration with clinical examples.

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“…In another study of 31 patients who underwent living donor liver transplantation with recurrent HCV infection to compare the accuracy of MRE, TE, and serum biomarkers (APRI and fibro α score to identify advanced fibrosis defined by Metavir stage ≥ 3, it showed MRE and fibro α score can accurately diagnose advanced fibrosis with AUROC of 0.708 and 0.833, respectively. The correlation of TE and APRI was not statistically significant to detect advanced fibrosis[ 48 ]. In a pooled analysis of MRE in LT recipients, AUROCs of MRE in detecting advanced fibrosis (stage ≥ 3) using a cut-off of 4.10 kPa and cirrhosis using a cut-off of 5.91 kPa were 0.83 and 0.96 respectively, suggesting high diagnostic accuracy[ 49 ].…”

Section: Diagnosismentioning

confidence: 99%

De novo and recurrence of metabolic dysfunction-associated fatty liver disease after liver transplantation

Han¹,

Olivo²,

Choi³

et al. 2021

WJH

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Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new acronym adopted from the consensus of international experts. Given the increasing prevalence of MAFLD in pre-transplant settings, de novo and recurrent graft steatosis/MAFLD are common in post-transplant settings. The impact of graft steatosis on long-term outcomes is unclear. The current knowledge of incidence rate, risk factors, diagnosis, long-term outcomes, and management of graft steatosis (both de novo and recurrent) is discussed in this review.

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Non-Invasive Assessment of Graft Fibrosis After Living Donor Liver Transplantation: Is There Still a Role for Liver Biopsy?

Cited by 11 publications

References 16 publications

Transient Hepatic Elastography in the Assessment of Liver Fibrosis in Patients After Liver Transplantation

Transient Hepatic Elastography in the Assessment of Liver Fibrosis in Patients After Liver Transplantation

Elastography in the evaluation of liver allograft

De novo and recurrence of metabolic dysfunction-associated fatty liver disease after liver transplantation

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