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

Abstract

Noninvasive serum fibrosis biomarkers predict clinical outcomes in pretransplant patients with chronic liver disease. We investigated the role of serum fibrosis biomarkers and of changes in biomarkers in predicting death and graft loss after liver transplantation (LT). We included 547 patients who underwent LT between 1991 and 2012 and who met the following criteria: patient and graft survival > 12 months; serum fibrosis biomarkers aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis score 4 (FIB-4), and nonalcoholic fatty liver disease (NAFLD) fibrosis score available at 1 year after LT; and a minimum follow-up of 1 year. Delta of fibrosis biomarkers was defined as (end of follow-up score -baseline score)/followup duration. Baseline and delta fibrosis biomarkers were associated with death: APRI > 1.5 (adjusted hazard ratio [aHR], 2.2; 95% confidence interval [CI], 1.4-3.3; P < 0.001) and delta APRI > 0.5 (aHR, 5.3; 95% CI, 3.4-8.2; P < 0.001); FIB-4 > 3.3 (aHR, 1.9; 95% CI, 1.3-2.8; P 5 0.002) and delta FIB-4 > 1.4 (aHR, 2.4; 95% CI, 1.4-4.1; P 5 0.001); and NAFLD fibrosis score > 0.7 (aHR, 1.9; 95% CI, 1.3-2.9; P 5 0.002) and delta NAFLD fibrosis score (aHR, 3.7; 95% CI, 2.6-5.4; P < 0.001). Baseline and delta fibrosis biomarkers were associated also with graft loss. In conclusion, serum fibrosis biomarkers 1 year after LT and changes in serum fibrosis biomarkers predict death and graft loss in LT recipients. They may help in risk stratification of LT recipients and identify patients requiring closer monitoring.

Performance of transient elastography and serum fibrosis biomarkers for non-invasive evaluation of recurrent fibrosis after liver transplantation: A meta-analysis

“…APRI and FIB-4 have been employed serially in LT recipients not only for diagnostic purposes, but also for prognosis. The fact that both biomarkers and their longitudinal changes predict long-term outcomes in the recipient, including death and graft loss, confirms their pathophysiologic link with liver damage[ 33 ]. A major issue for both APRI and FIB-4 remains the wide range of cut-off values adopted in different studies to diagnose significant liver fibrosis, which may limit their applicability in clinical practice.…”

Predictors of De Novo Nonalcoholic Fatty Liver Disease After Liver Transplantation and Associated Fibrosis

“…In pre‐LT NAFLD, FIB‐4 has been shown to have the best diagnostic accuracy for advanced fibrosis (area under the receiver operating characteristic curve [AUROC], 0.86), followed by the AAR (AUROC, 0.83) and NFS (AUROC, 0.81) . The use of these fibrosis scores in the general post‐LT setting has been less promising (AUROCs: APRI, 0.68; FIB‐4, 0.72; and NFS, 0.75) …”

“…(22) The use of these fibrosis scores in the general post-LT setting has been less promising (AUROCs: APRI, 0.68; FIB-4, 0.72; and NFS, 0.75). (23) Our aims in this study included the following:…”

The Role of Beta-7 Integrin and Carbonic Anhydrase IX in Predicting the Occurrence of de Novo Nonalcoholic Fatty Liver Disease in Liver Transplant Recipients

“…APRI, FIB-4 and NAFLD fibrosis scores, all based on serum biomarkers, have already been validated as tools for measuring fibrosis in liver transplant recipients with good AUROCs in predicting mortality, liver related mortality and graft loss (5), and they can change acutely with the onset of liver complications.…”