Transient elastography reliably estimates liver fibrosis in autoimmune hepatitis

Mahmud, Nadim; Doshi, Sahil; Forde, Kimberly A.; Khungar, Vandana

doi:10.5114/ceh.2019.87639

Cited by 11 publications

(12 citation statements)

References 23 publications

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“…TLE was initially applied in the 1990s and approved by the Food and Drug Administration in 2013 11 . It is an ultrasound technique that assesses the degree of liver stiffness, in a fast and versatile way, and can be applied in all superficial solid organ (breast, thyroid, spleen, kidneys, and prostate) 14 .…”

Section: Tlementioning

confidence: 99%

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Papel de la elastografía hepática transitoria en la evaluación de la fibrosis hepática en la hepatitis autoinmune pediátrica

Rocha-Alvarenga¹,

Bellomo-Brandao²

2022

LAJPGN

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Section: Tlementioning

confidence: 99%

“…However, transient liver elastography (TLE) has the advantage of being a non-invasive method that evaluates a larger liver fraction than the biopsy. The method has been improved over the years and has already been validated in several chronic liver diseases, including AIH [11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

Papel de la elastografía hepática transitoria en la evaluación de la fibrosis hepática en la hepatitis autoinmune pediátrica

Rocha-Alvarenga¹,

Bellomo-Brandao²

2022

LAJPGN

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“…4 It is also associated with potential for sampling error and high interobserver variability. [5][6][7][8] Serum liver enzymes, such as alanine aminotransferase and aspartate aminotransferase are used to inform clinical management. However, their normalisation does not always exclude underlying residual hepatic inflammation.…”

Section: Introductionmentioning

confidence: 99%

LiverMultiScan as an alternative to liver biopsy to monitor autoimmune hepatitis in the National Health Service in England: an economic evaluation

et al. 2022

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BackgroundAutoimmune hepatitis (AIH) is a rare chronic progressive liver disease, managed with corticosteroids and immunosuppressants and monitored using a combination of liver biochemistry and histology. Liver biopsy (gold standard) is invasive, costly and has risk of complications. Non-invasive imaging using multiparametric magnetic resonance (mpMR) can detect the presence and extent of hepatic fibroinflammation in a risk-free manner.ObjectiveTo conduct early economic modelling to assess the affordability of using mpMR as an alternative to liver biopsy.MethodsMedical test costs associated with following 100 patients over a 5-year time horizon were assessed from a National Health Service payor perspective using tariff costs and average biopsy-related adverse events costs. Sensitivity analyses modelling the cost consequences of increasing the frequency of mpMR monitoring within the fixed cost of liver biopsy were performed.ResultsPer 100 moderate/severe AIH patients receiving an annual mpMR scan (in place of biopsy), early economic modelling showed minimum cost savings of £232 333. Per 100 mild/moderate AIH patients receiving three mpMR scans over 5 years estimated minimum cost savings were £139 400. One-way sensitivity analyses showed increasing the frequency of mpMR scans from 5 to 10 over 5 years in moderate/severe AIH patients results in a cost saving of £121 926.20. In patients with mild/moderate AIH, an increase from 3 to 6 mpMR scans over 5 years could save £73 155.72. In a minimalistic approach, the use of 5 mpMR scans was still cost saving (£5770.48) if they were to replace two biopsies over the 5-year period for all patients with moderate/severe or mild/moderate AIH.ConclusionsIntegration of mpMR scans in AIH patient pathways leads to significant cost savings when liver biopsy frequency is either reduced or eliminated, in addition to improved patient experience and clinician acceptability as well as providing detailed phenotyping to improve patient outcomes.Trial registrationNCT03979053.

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“…( 4 ) The results of studies assessing the performance of VCTE in AIH have been confounded by the contribution of inflammation in the interpretation of liver stiffness measurement (LSM), especially during the first 6 months after treatment initiation. ( 4‐9 ) As a result, it has been difficult to identify consistent cutoff points for the diagnosis of AIH‐related cirrhosis. ( 5,7 ) Furthermore, these studies have additional limitations: (1) The number of patients with cirrhosis was low, and (2) there was a lack of data on the clinical predictive value of LSM in patients with AIH‐related cirrhosis.…”

mentioning

confidence: 99%

“…treatment initiation. (4)(5)(6)(7)(8)(9) As a result, it has been difficult to identify consistent cutoff points for the diagnosis of AIH-related cirrhosis. (5,7) Furthermore, these studies have additional limitations: (1) The number of patients with cirrhosis was low, and (2) there was a lack of data on the clinical predictive value of LSM in patients with AIH-related cirrhosis.…”

mentioning

confidence: 99%

Noninvasive Prediction of Outcomes in Autoimmune Hepatitis–Related Cirrhosis

et al. 2022

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The value of noninvasive tools in the diagnosis of autoimmune hepatitis (AIH)–related cirrhosis and the prediction of clinical outcomes is largely unknown. We sought to evaluate (1) the utility of liver stiffness measurement (LSM) in the diagnosis of cirrhosis and (2) the performance of the Sixth Baveno Consensus on Portal Hypertension (Baveno VI), expanded Baveno VI, and the ANTICIPATE models in predicting the absence of varices needing treatment (VNT). A multicenter cohort of 132 patients with AIH‐related cirrhosis was retrospectively analyzed. LSM and endoscopies performed at the time of cirrhosis diagnosis were recorded. Most of the patients were female (66%), with a median age of 54 years. Only 33%‐49% of patients had a LSM above the cutoff points described for the diagnosis of AIH‐related cirrhosis (12.5, 14, and 16 kPa). Patients with portal hypertension (PHT) had significantly higher LSM than those without PHT (15.7 vs. 11.7 kPa; P = 0.001), but 39%‐52% of patients with PHT still had LSM below these limits. The time since AIH diagnosis negatively correlated with LSM, with longer time being significantly associated with a lower proportion of patients with LSM above these cutoffs. VNT was present in 12 endoscopies. The use of the Baveno VI, expanded Baveno VI criteria, and the ANTICIPATE model would have saved 46%‐63% of endoscopies, but the latter underpredicted the risk of VNT. Conclusions: LSM cutoff points do not have a good discriminative capacity for the diagnosis of AIH‐related cirrhosis, especially long‐term after treatment initiation. Noninvasive tools are helpful to triage patients for endoscopy.

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Transient elastography reliably estimates liver fibrosis in autoimmune hepatitis

Cited by 11 publications

References 23 publications

Papel de la elastografía hepática transitoria en la evaluación de la fibrosis hepática en la hepatitis autoinmune pediátrica

Papel de la elastografía hepática transitoria en la evaluación de la fibrosis hepática en la hepatitis autoinmune pediátrica

LiverMultiScan as an alternative to liver biopsy to monitor autoimmune hepatitis in the National Health Service in England: an economic evaluation

Noninvasive Prediction of Outcomes in Autoimmune Hepatitis–Related Cirrhosis

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