Transient Elastography in Acute Cellular Rejection Following Liver Transplantation: Systematic Review

Nacif, Lucas Souto; Gomes, C.d.C.; Mischiatti, Marilia; Kim, V.; Paranaguá‐Vezozzo, Denise Cerqueira; Reinoso, Giselle; Carrilho, F.; D’Albuquerque, Luiz Carneiro

doi:10.1016/j.transproceed.2018.02.008

Cited by 11 publications

(6 citation statements)

References 7 publications

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“…ACR, as an inflammatory process, has previously been shown to increase liver stiffness in children and adults and, therefore, is a potential confounder for the performance of TE. 19,31,32 In our study, only 6 subjects experienced ACR within 21 days of biopsy.…”

Section: Discussionmentioning

confidence: 65%

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Transient elastography assessment of liver allograft fibrosis in pediatric transplant recipients

Lee

Nastasio

Mitchell

et al. 2020

Pediatric Transplantation

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TE measures liver stiffness to assess fibrosis. Its use in post‐transplant patients was reported in few small pediatric studies. We evaluated TE ability to predict liver graft fibrosis in a large cohort while comparing it to the performance of APRI and FIB‐4. We also investigated the effect of graft type on LSMs. Patients at Boston Children's Hospital who underwent LT and LSM ≤ 1 year from biopsy (2007‐2018) were eligible. Ninety‐four patients (45%M) aged 1‐21 years (89% < 18 years; 13% < 2 years) were eligible. Median time between transplant/biopsy and LSM was 5.1 years and 52 days, respectively. Thirty‐nine percent received whole‐liver grafts, 54% TV grafts, and 6% as part of MV. At LSM, median ALT was 25 [IQR 16‐33] IU/L. Twenty‐one percent had METAVIR ≥ F2. LSM was statistically higher among those with significant fibrosis (METAVIR ≥ F2) compared to those with METAVIR F0/F1 (median [IQR] 7.5 [4.6, 13.6] vs 5.1 [4.0, 6.4] kPa, respectively) (P = .005 by Wilcoxon rank‐sum test). APRI and FIB‐4 distributions were not different across METAVIR stages. The AUROC for LSM was 0.71 (95% CI 0.56‐0.85) with an optimal cut‐point of 6.5 kPa. Graft type had no influence on the AUROC for LSM. TE is useful for assessing significant graft fibrosis in children and young adult LT recipients and performs better than APRI and FIB‐4. TV grafts demonstrate similar correlation with histology as whole‐liver grafts.

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Section: Discussionmentioning

confidence: 65%

“…as part of MV. At LSM, median ALT was 25 [IQR [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]] IU/L. Twenty-one percent had METAVIR ≥ F2.…”

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confidence: 99%

Transient elastography assessment of liver allograft fibrosis in pediatric transplant recipients

Lee

Nastasio

Mitchell

et al. 2020

Pediatric Transplantation

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“…Acute cellular rejection is a common lymphocyte-mediated immune response that occurs following liver transplantation 37 . Rejection may affect the survival rates after liver transplantation 7 .…”

Section: Discussionmentioning

confidence: 99%

Hypothermic oxygenated perfusion in liver transplantation: a meta-analysis of randomized controlled trials and matched studies

Tang,

Zhang,

Xia

et al. 2023

International Journal of Surgery

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Background: Hypothermic Oxygenated Machine Perfusion (HOPE) is a novel organ-preservation technology designed to optimize organ quality. However, the effects of HOPE on morbidity and mortality after liver transplantation remain unclear. This meta-analysis evaluated the potential benefits of HOPE in liver transplantation. Materials and methods: The Embase, Web of Science, PubMed, Cochrane Library, and Scopus databases were searched for articles published up to June 15, 2023 (updated on August 12, 2023). Mean differences (MD), risk ratios (RR), and 95% confidence intervals were calculated. Results: Eleven studies encompassing five randomized controlled trials and six matched studies were included, with a total of 1000 patients. HOPE did not reduce the incidence of major postoperative complications (RR 0.80), primary nonfunction (PNF) (RR 0.54), reperfusion syndrome (RR 0.92), hepatic artery thrombosis (RR 0.92), renal replacement therapy (RR 0.98), length of hospital stay (MD, −1.38 d), 1-year recipient death (RR 0.67), or intensive care unit stay (MD, 0.19 d) after liver transplantation. HOPE reduced the incidence of biliary complications (RR 0.74), non-anastomotic biliary strictures (NAS) (RR 0.34), early allograft dysfunction (EAD) (RR 0.54), and acute rejection (RR 0.54). In addition, HOPE improved the retransplantation (RR 0.42) and 1-year graft loss rates (RR 0.38). Conclusions: Compared with static cold storage (SCS), HOPE can reduce the incidence of biliary complications, NAS, EAD, and acute rejection and retransplantation rate after liver transplantation and improve the 1-year graft loss rate. These findings suggest that HOPE, when compared to SCS, can contribute to minimizing complications and enhancing graft survival in liver transplantation. Further research is needed to investigate long-term outcomes and confirm the promising advantages of HOPE in liver transplantation settings.

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“…Overall, data are limited regarding this population; a recent systematic review found only 3 studies comprising 33 total patients with ACR who were evaluated with TE . Further, although an increased LS may in fact suggest underlying ACR, it does not add much to a clinician's decision‐making process in the acute setting, that is, whether a liver biopsy is necessary or whether an empiric increase in immunosuppression is warranted .…”

Section: Methodsmentioning

confidence: 99%

A review of the use of transient elastography in the assessment of fibrosis and steatosis in the post–liver transplant patient

Winters

Mittal

Schiano

2019

Clinical Transplantation

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Liver biopsy is considered the gold standard method for diagnosing and staging liver disease, particularly in the post-liver transplant setting. Given the invasive nature of biopsy, alternate means for accurately assessing liver fibrosis and steatosis are preferred especially as the number of patients with fatty liver disease is increasing.Transient elastography has been validated as a useful tool for evaluation of liver fibrosis, as has controlled attenuation parameter index as a tool for assessing steatosis. It is a non-invasive, rapid, and highly reproducible approach to demonstrate the presence of fibrosis among non-transplant patients with chronic liver disease of various etiologies. However, it has not yet found wide acceptance in liver transplant recipients. There are few published studies evaluating the merits and applicability of transient elastography to assess allografts after liver transplantation. We review the published data on the use of transient elastography with concurrent controlled attenuation parameter in liver transplant recipients and recommend its greater use to follow allograft function over time.

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Transient Elastography in Acute Cellular Rejection Following Liver Transplantation: Systematic Review

Cited by 11 publications

References 7 publications

Transient elastography assessment of liver allograft fibrosis in pediatric transplant recipients

Transient elastography assessment of liver allograft fibrosis in pediatric transplant recipients

Hypothermic oxygenated perfusion in liver transplantation: a meta-analysis of randomized controlled trials and matched studies

A review of the use of transient elastography in the assessment of fibrosis and steatosis in the post–liver transplant patient

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