Introduction The role of transient elastography (TE) or Fibroscan in assessing severity of liver fibrosis has been validated against liver biopsy in chronic hepatitis B and C and in NAFLD. There are few studies assessing its role in autoimmune hepatitis (AIH). Four preliminary studies have reported data on the role of Fibroscan in AIH. In these, most patients had recently started treatment and thus, still had active disease. Minimal data on transaminases was provided. We aimed to assess the accuracy of Fibroscan in predicting histological fibrosis severity in patients who had achieved biochemical remission (normal transaminases) and were undergoing follow-up liver biopsy to confirm histological remission as per our Unit’s clinical policy.
Methods Between 1/12/13 and 31/12/15 36 same-day Fibroscan and liver biopsy were performed in 32 patients with AIH (1999 International Group criteria; 25 female, age 56 (17–78) years who had achieved biochemical remission (normal serum ALT and globulins) after 2.7 (2.1–24.9) years treatments. No patient had ascites, extrahepatic cholestasis or congestive cardiac failure based on clinical and laboratory evaluation.
Fibroscan was performed in fasted patients using the Echosens machine (M or XL probe used as needed) by trained operators. We assessed how accurately the liver stiffness evaluation (LSE) score on Fibroscan could predict Ishak fibrosis stage on biopsy (assessed independently by AKD).
Results The ALT was 21 (9–99), normal value <33. 89% patients had normal serum ALT on the day. Ishak necroinflammatry score ≤3 (histological remission) was present in 12 biopsies (33%). Of the 36 Fibroscan’s carried out, 27 were valid. A valid scan defined by: ≥10 liver stiffness measurements, interquartile range (IQR)/median of <0.30 and a success rate ≥ 60%.
Conclusion In this study, Fibroscan showed good accuracy in excluding, but lower accuracy in predicting Ishak fibrosis stage of 4 or more. Accuracy was improved if a valid scan was obtained. Fibroscan was less accurate in predicting lower fibrosis stages. A combination of methods of assessing liver fibrosis may be necessary in some patients.
Disclosure of Interest None Declared