The Reliability of Fibro-test in Staging Orthotopic Liver Transplant Recipients with Recurrent Hepatitis C

Abstract

Background and Aims: Liver biopsy remains the gold standard for staging of chronic liver disease following orthotopic liver transplantation. Noninvasive assessment of fibrosis with Fibrotest (FT) is well-studied in immunocompetent populations with chronic hepatitis C virus infection. The aim of this study is to investigate the diagnostic value of FT in the assessment of hepatic fibrosis in the allografts of liver transplant recipients with evidence of recurrent hepatitis C. Methods: We retrospectively compared liver biopsies and FT performed within a median of 1 month of each other in orthotopic liver transplantation recipients with recurrent hepatitis C. Results: The study population comprised 22 patients, most of them male (19/22), and with median age of 62 years. For all patients, there was at least a one-stage difference in fibrosis as assessed by liver biopsy compared to FT, while for the majority (16/22) there was at least a two-stage difference. The absence of correlation between the two modalities was statistically demonstrated (Mann-Whitney U test, p = 0.01). In detecting significant fibrosis (a METAVIR stage of F2 and above), an FT cutoff of 0.5 showed moderate sensitivity (77%) and negative predictive value (80%), but suboptimal specificity (61%) and positive predictive value (58%). Conclusions: In post-transplant patients with recurrent hepatitis C, FT appears to be inaccurately assessing the degree of allograft fibrosis, therefore limiting its reliability as a staging tool.

A Diagnostic Test Meta‐Analysis Evaluating Imaging‐Based and Blood Biomarker–Based Assessment Tools for Fibrosis After Liver Transplantation

“…In total, 25 articles were included in the final review, with a cumulative sample size of 1829 patients. Of these, 14 articles originated from Europe, (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) 6 articles from North America, (2,(34)(35)(36)(37)(38) 3 from Asia, (39)(40)(41) 1 from South America, (42) and 1 from the Middle East region. (43) Supporting Information 2 describes the baseline characteristics of the included articles.…”

“…The time to assessment of liver fibrosis from LT was 51.60 months. The METAVIR scoring system was the most common definition for fibrosis in 17 studies, (2,(20)(21)(22)(23)(24)28,31,34,(36)(37)(38)(39)(41)(42)(43)(44) followed by 5 studies using the Scheur scoring system, (25,27,29,30,40) 2 studies using the Batts-Ludwig system, (26,33) and 1 study using the Ishak fibrosis score. (32) In the QUADAS-2 assessment of the included articles, a majority of the articles were determined to have low risk of bias.…”

A Comprehensive Review of Liver Allograft Fibrosis and Steatosis: From Cause to Diagnosis

“…Additional indices include the London Transplant Center score and FibroTest (BioPredictive, Paris, FR) with similar accuracy. 91-93…”

“…Additional indices include the London Transplant Center score and FibroTest (BioPredictive, Paris, FR) with similar accuracy. [91][92][93] Several studies also independently investigated the accuracy of different fibrotic markers; however, this was primarily developed for the recurrent HCV population. Certain examples include the enhanced liver fibrosis score that integrates hyaluronic acid, PIII3NP, and tissue inhibitor of metalloproteinase-1 variables, 94 hyaluronic acid and YKL-40, an inflammatory glycoprotein for predicting rapid fibrosis progression for patients with HCV.…”