Transient elastography in the assessment of liver fibrosis in adult thalassemia patients

Abstract

Transient elastography (TE) is a valuable noninvasive technique of measuring liver stiffness and a reliable tool for predicting hepatic fibrosis in patients with chronic liver disease. The role of TE in patients with β‐thalassemia has not been extensively investigated. The present study aimed to evaluate the role of TE in the assessment of hepatic fibrosis in 115 adult patients with β‐thalassemia major (TM) (#59) or intermedia (TI) (#56). TE was performed according to current practice. Histologic data were obtained in 14 cases. Liver iron concentration was assessed by atomic absorption spectrometry and T2* magnetic resonance. In patients with TM, the proportion of anti‐HCV positive viremic patients, median serum ferritin levels, and TE values were significantly higher than in TI. In the group of 14 patients who underwent liver biopsy, a significant positive correlation was observed between liver stiffness and fibrosis stage (r = 0.73, P = 0.003). Severe fibrosis is diagnosed with a sensitivity of 60% and a specificity of 89%, whereas cirrhosis is detected with a sensitivity of 100% and a specificity of 92%. At multivariate analysis, the variables independently associated with TE were ALT, GGT, and bilirubin levels in both groups and, in patients with TM, HCV RNA positivity. In β‐thalassemia patients, TE is a reliable tool for assessing liver fibrosis even if the influence of iron overload has to be clarified. Am. J. Hematol. 85:564–568, 2010. © 2010 Wiley‐Liss, Inc.

Hepatology Clinical

“…Associations between risk factors and loge TE were compared by linear regression, and associations between TE thresholds (>7.9 kPa for F ≥ 2, >10.3 for F≥3, >11.9 for F = 4) versus normal, by logistic regression. (4,5) Results: 18/63 (29%) had evidence of fibrosis, including 7/63 (11%) with cirrhosis by TE (of whom the diagnosis was not been previously known in six). By multiple logistic regression, present and 15 year-old ferritin levels, presence of HCV Ab and age independently predicted TE.…”

“…Relevant patient data were extracted from medical records, with liver tests (LTs) assessed prior to commencement of allopurinol, 1-3 months post and 3-6 months post whilst maintaining the same dose of thiopurine. Data are presented as mean and standard deviation [SD] [5] (NS). No significant difference in any LT was noted at 3-6 months.…”

“…Endoscopic examinations for patients with cirrhosis are performed as per protocol. Patients are referred back to the medical clinic if they exhibit (1) impaired synthetic function -raised INR or fall in albumin (2) excessive weight gain or weight loss (3) abnormal ultrasound (4) raised AFP (5) nurse is concerned about the patient. Results: A total of 41 patients (30 males, 11 females, mean age 59.1 years) were seen.…”

Virtual touch tissue quantification of liver in thalassemia

“…Frequent blood transfusion and increased gastrointestinal absorption of iron can lead to secondary iron overload. 1 Excess free iron mediates organ injury through lipid peroxidation of organelle membrane, increased lysosomal fragility and decreased mitochondrial oxidative metabolism. Liver is the primary site of iron storage and only site of synthesis of transferrin and ferritin.…”

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

“…Another approach, transient elastography (TE), has also been used as a reliable, noninvasive tool for evaluating liver fibrosis, showing comparable results to liver biopsy, especially in patients with chronic viral hepatitis and cirrhosis [12,13]. However, studies on TE's performance assessing liver fibrosis in MT patients and especially its impact on determining the LRC are still scarce in the literature [14,15].…”