Serial Liver Stiffness Measurements and Monitoring of Liver-Transplanted Patients in a Real-Life Clinical Practice

Abstract

BackgroundLiver transplanted patients need close surveillance for early signs of graft disease.ObjectivesTransient elastography can safely be repeated over time, offering serial liver stiffness measurement values. Serial stiffness measurements were compared to single baseline stiffness measurements in predicting the appearance of liver-related clinical events and guiding subsequent clinical decisions.MethodsOne hundred and sixty liver transplanted patients were observed for three years in our real-life practice.ResultsLiver stiffness measurements were stable in 75% of patients, decreased in 4% of patients, and increased in 21% of patients. The pattern of increased stiffness measurements was associated with both HCV-RNA positive status and the presence of an active biliary complication of liver transplantation and was more predictive of a clinically significant event resulting from any disease of the transplanted liver when compared to a stable pattern or to a single liver stiffness measurement. The procedures that were consequently performed were often diagnostic for unexpected situations, both in HCV-RNA positive and HCV-RNA negative patients.ConclusionsThe pattern of longitudinally increased liver stiffness measurements efficiently supported clinical decisions for individualized management strategies. Repeated transient elastography in real-life clinical practice appears to have a practical role in monitoring liver transplanted patients.

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

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Mechanisms of Non-Alcoholic Fatty Liver Disease in the Metabolic Syndrome. A Narrative Review

“…Risk factors for progression have been identified in CV disease, renal impairment, dyslipidemia and diabetes [ 193 ]. Hence, liver ultrasound (US) and the quantification of fat and fibrosis with transient elastography (Fibroscan) and Control Attenuation Parameter (CAP) software currently represent the non-invasive and inexpensive tools to diagnose NAFLD in the clinical practice [ 194 ]. Beyond these, also the evaluation of genetic polymorphisms (PNPLA3, TM6SF3, MBOTT) and scores (e.g., NAFDL fibrosis score, FIB4, APRI score) may support the identification of subjects at higher risk of disease progression [ 195 ].…”

Oncolytic Viruses in Combination Therapeutic Approaches with Epigenetic Modulators: Past, Present, and Future Perspectives

“…Therapeutic treatments are very complicated, as only a few patients, especially in the initial phase, can undergo surgery. Conversely, oral therapy with sorafenib, a kinase inhibitor, is indicated for patients in more advanced stages of cancer, but, unfortunately, is frequently associated with the onset of resistance within six months of treatment [ 12 , 13 , 14 , 15 , 16 , 17 ]. Furthermore, alongside this problem, long-term use of most chemotherapy drugs, including sorafenib, results in toxicity and ineffectiveness of the drug [ 18 , 19 , 20 , 21 ].…”