Transient elastography predicts fibrosis progression in patients with recurrent hepatitis c after liver transplantation

Cristina Rigamonti ^1*, Maria F Donato ¹, Mirella Fraquelli ¹, Francesca Agnelli ¹, Guido Ronchi ¹, Giovanni Casazza ², Giorgio Rossi ¹ and Massimo Colombo ¹

¹ Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena and University of Milan, Italy
² Istituto di Statistica Medica e Biometria, University of Milan, Italy

^* To whom correspondence should be addressed. E-mail: crigamo{at}tin.it.

Accepted 15 January 2008

Abstract

Objective: Transient elastography (TE) allows non-invasive evaluation of liver disease severity in patients with chronic hepatitis C. This procedure, however, warrants further validation in the setting of liver transplantation (LT), including patients under follow-up for recurrent hepatitis C.

Setting: Tertiary referral hospital. Patients: 95 patients (75 males) transplanted for end-stage liver disease due to hepatitis C virus. Interventions: Paired liver biopsy (LB) and TE were carried out 6 to 156 (median 35) months after LT. 40 patients with recurrent hepatitis C sequentially evaluated 6 to 21 months apart.

Main outcome measures: Clinical, laboratory and graft histological features influencing TE results.

Results: Median TE values were 7.6 kPa in the 90 patients with a successful TE examination, being 5.6 kPa in the 30 patients with Ishak fibrosis score (S) of 0-1, 7.6 kPa in the 38 with S2-3; 16.7 kPa in the 22 with S4-6, (p<0.0001). The areas under ROC curves were 0.85 (95%CI: 0.76-0.92) for S3, 0.90 (95%CI: 0.82-0.95) for S4 with 7.9 and 11.9 kPa optimal TE cut-off (81% and 82% sensitivity, 88% and 94% negative predictive value, respectively). Fibrosis, necroinflammatory activity and higher than 200 IU/L gamma-glutamyl transpeptidase levels independently influenced TE results. During post-LT follow-up, TE results changed in parallel with grading (r=0.63) and staging (r=0.71), showing 86% sensitivity and 92% specificity in predicting staging increases.

Conclusions: TE accurately predicts fibrosis progression in LT patients with recurrent hepatitis C, suggesting that protocol LB might be avoided in patients with improved or stable TE values during follow-up.

Keywords: graft disease, hepatitis C recurrence, liver biopsy, liver transplantation, transient elastography

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