Noninvasive Measurement of Liver Fibrosis Using Transient Elastography in Pediatric Patients with Major Thalassemia Who Are Candidates for Hematopoietic Stem Cell Transplantation

Abstract

Although liver biopsy is an invasive procedure, it remains the gold standard technique for the evaluation of hepatic fibrosis in different patients, including those with major thalassemia (MT). Recently, noninvasive imaging techniques, such as transient elastography, have emerged. We investigated the effectiveness of TE, in comparison to liver biopsy, for the evaluation of liver fibrosis in pediatric patients with MT who were candidates for hematopoietic stem cell transplantation (HSCT). Eighty-three pediatric MT patients (48 boys and 35 girls), who were candidates for HSCT, were included in this study. The median age was 8 years. Liver stiffness was assessed for all patients, before transplantation, using both TE, measured in kilopascals (kPa) and liver biopsy, based on the Metavir score. The diagnostic accuracy of TE and liver biopsy were estimated using linear discriminated analysis (the area under the receiver operating characteristic curves [AUROCs]). The median TE score was 4.3 kPa (range, 3.5 to 5.2). The TE value did not differ among patients with different ferritin levels (P = .53). TE increased proportionally to Metavir fibrosis stages (P < .001) and the necro-inflammatory grade (P < .001). The TE score also correlated to liver iron content (P < .001), liver size (P < .003), and Lucarelli risk classification (LRC) (P < .001). ROC curve analysis revealed moderate accuracy of the TE score for the diagnosis of fibrosis (AUROC = 73%) and for distinguishing individuals with a LRC III from those classified as I and II (AUROC = 82%). The TE score was also superior to Fibrosis-4 (AUROC = 61%) for the assessment of liver fibrosis and LRC differentiation. The results of this study demonstrated that TE can be a valuable method for assessing liver fibrosis and differentiating LRC III from the other 2 classes in pediatric patients with MT who have been selected for HSCT.

Ultrasound Elastography Is Useful for Evaluation of Liver Fibrosis in Children—A Systematic Review

“…Eight studies did not find any effect of age (19,23,24,31,37,(43)(44)(45). Success rates were lower in younger children (14,19,21,23,43,44).…”

“…Boys had higher liver stiffness values compared with girls in two studies (21,45), but in six studies gender had no effect on measurements (19,22,23,37,41,42). BMI did not influence liver stiffness in four studies (22,24,31,41), while a high BMI lead to unsuccessful measurement in other studies (23,34,37). Increasing necroinflammatory grade was correlated to increasing liver stiffness in two studies (24,25).…”

Noninvasive assessment and risk factors of liver fibrosis in patients with thalassemia major using shear wave elastography

“…It is becoming an attractive technology for assessment of liver fibrosis as it is readily available, non-invasive, accurate, low cost, reproducible, and suitable for use in a variety of clinical settings. There are limited data about the role of Transient Elastography (TE) in the assessment of liver fibrosis in patients with TM and no data on the utility of the 2-D SWE imaging technique in such cases [10][11][12][13]. Therefore, the present study aimed to stage liver fibrosis in patients with TM using the 2-D SWE imaging technique in staging hepatic fibrosis and evaluating risk factors associated with significant fibrosis.…”

Inverse Association of Plasma Level of Glutathione Peroxidase with Liver Fibrosis in Chronic Hepatitis B: Potential Role of Iron

“…However, we had previously demonstrated the correlation of transient elastography with histological measure of hepatic iron deposition. 2 , 19 , 20 Therefore, we used the liver stiffness as an indirect measure of both liver fibrosis and liver iron deposit. We demonstrated that plasma level of Gpx was inversely associated with HBV DNA count and liver stiffness whereas serum iron was positively associated with HBV DNA count and was indirectly affecting the liver stiffness.…”