Determination of allograft fibrosis by measurement of liver stiffness using transient elastography in children after liver transplantation at Shiraz Organ Transplant Center
Gastroenterology and Hepatology from Bed to Bench,
23 August 2021
Introduction: Liver stiffness (LS) assessment using fibro-scanning (transient elastography-TE) is a non-invasive method for the evaluation of liver fibrosis. The aim of this study was to determine allograft fibrosis by measuring LS using TE in children after liver transplantation at Shiraz Organ Transplant Center.
Methods: All children undergoing liver transplant from 2012 to 2016 were included in the study. Demographic data, graft type, immunosuppressive drugs, as well as clinical and paraclinical data were obtained from patients’ records. TE was performed to determine LS in all patients. Liver fibrosis was also confirmed based on Metavir score.
Results: During this period more than 400 liver Tx were done in children but just 54 were available and willing to this study .54 patients including 20 (37%) girls and 34 (63%) boys who underwent liver transplantation were studied. The mean age of the patients was 12.96 ±5.32 years. Correlations between FS score (LS) and AST (P = 0.01), total bilirubin (P = 0.002), albumin (P = 0.001), PT (P = 0.03), and INR (P = 0.001) were significant. There was no significant relationship between FS score (LS) and type of allograft (P = 0.79) and underlying disease (P = 0.36). Positive and significant correlations were observed between Metavir score and AST (P = 0.01), total bilirubin (P = 0.01), INR (P = 0.004) and cholesterol (P = 0.001). The severity of fibrosis significantly and negatively correlated with albumin (P = 0.004) and glucose (P = 0.003). Also, there was no significant relationship between Metavir score and allograft type (P = 0.7).
Conclusion: Our study demonstrated that 14.9% of LT patients had a METAVIR ≥ F2. The time between LT and TE was significantly correlated with LS, and the degree of liver fibrosis based on Metavir score. However, there was no significant relationship between LS with allograft type as well as underlying liver disease
- Transient Elastography, Liver Transplantation, Allograft Fibrosis
Duffy JP, Kao K, Ko CY, Farmer DG, McDiarmid SV, Hong JC, et al. Long-term patient outcome and quality of life after liver transplantation: analysis of 20-year survivors. Ann Surg 2010; 252 (4):652-61.
Hübscher SG. What is the long-term outcome of the liver allograft? J Hepatol 2011; 55 (3): 702-17.
Ueno T, Tanaka N, Ihara Y, Takama Y, Yamada H, Mushiake S, Fukuzawa M. Graft fibrosis in patients with biliary atresia after pediatric living-related liver transplantation. Pediatr Transplant 2011; 15 (5): 470-5.
Ekong UD, Melin-Aldana H, Seshadri R, Lokar J, Harris D, Whitington PF, Alonso EM. Graft histology characteristics in long-term survivors of pediatric liver transplantation. Liver Transpl 2008; 14 (11): 1582-7.
Tomita H, Hoshino K, Fuchimoto Y, Ebinuma H, Ohkuma K, Tanami Y, et al. Acoustic radiation force impulse imaging for assessing graft fibrosis after pediatric living donor liver transplantation: a pilot study. Liver Transpl 2013; 19 (11): 1202-13.
Dattani N, Baker A, Quaglia A, Melendez HV, Rela M, Heaton N. Clinical and histological outcomes following living-related liver transplantation in children. Clin Res Hepatol Gastroenterol 2014; 38 (2): 164-71.
Sanada Y, Matsumoto K, Urahashi T, Ihara Y, Wakiya T, Okada N, et al. Protocol liver biopsy is the only examination that can detect mid-term graft fibrosis after pediatric liver transplantation. World J Gastroenterol 2014; 20 (21): 6638-50.
Scheenstra R, Peeters PM, Verkade HJ, Gouw AS. Graft fibrosis after pediatric liver transplantation: ten years of follow-up. Hepatology 2009; 49 (3): 880-6.
Kelly DA, Bucuvalas JC, Alonso EM, Karpen SJ, Allen U, Green M, et al. Long-term medical management of the pediatric patient after liver transplantation: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transpl 2013; 19 (8): 798-825.
Kelly D, Verkade HJ, Rajanayagam J, McKiernan P, Mazariegos G, Hübscher S. Late graft hepatitis and fibrosis in pediatric liver allograft recipients: Current concepts and future developments. Liver Transpl 2016; 22 (11): 1593-1602.
Lutz HH, Schroeter B, Kroy DC, Neumann U, Trautwein C, Tischendorf JJ. Doppler Ultrasound and Transient Elastography in Liver Transplant Patients for Noninvasive Evaluation of Liver Fibrosis in Comparison with Histology: A Prospective Observational Study. Dig Dis Sci 2015; 60 (9): 2825-31.
Crespo G, Lens S, Gambato M, Carrión JA, Mariño Z, Londoño MC, et al. Liver stiffness 1 year after transplantation predicts clinical outcomes in patients with recurrent hepatitis C. Am J Transplant 2014; 14 (2): 375-83.
Fitzpatrick E, Quaglia A, Vimalesvaran S, Basso MS, Dhawan A. Transient elastography is a useful noninvasive tool for the evaluation of fibrosis in paediatric chronic liver disease. J Pediatr Gastroenterol Nutr 2013; 56 (1): 72-6.
Goldschmidt I, Stieghorst H, Munteanu M, Poynard T, Schlue J, Streckenbach C, Baumann U. The use of transient elastography and non-invasive serum markers of fibrosis in pediatric liver transplant recipients. Pediatr Transplant 2013; 17 (6): 525-34.
Barrault C, Roudot-Thoraval F, Tran Van Nhieu J, Atanasiu C, Kluger MD, Medkour F, et al. Non-invasive assessment of liver graft fibrosis by transient elastography after liver transplantation. Clin Res Hepatol Gastroenterol 2013; 37 (4): 347-52.
Yoon H.M, Kim S.Y, Kim Y.M, Oh S.H, Ko G.Y, Park Y, et al. Liver Stiffness Measured by Shear-wave Elastography for Evaluating Intrahepatic Portal Hypertension in Children. JPGN 2017; 64(6), 892-897.
Pang J.X.Q, Zimmer S, Niu S, Crotty P, Tracey J, Pradhan F, et al. Liver Stiffness by Transient Elastography Predicts Liver-Related Complications and Mortality in Patients with Chronic Liver Disease. PLoS ONE 2014; 9(4): e95776. doi:10.1371.
Hormati A, Hajiani E, Shayesteh A.A, Masjedizadeh A.R, Hashemi S.J, Seyedian S.S, et al The Diagnostic Value Non Invasive Tests in Predicting Liver Fibrosis. Jundishapur Sci Med J 2014; 13(5): 533-543.
Rigamonti C, Fraquelli M, Bastiampillai A.J, Caccamo L, Reggiani P, Rossi G, et al. Transient Elastography Identifies Liver Recipients with Nonviral Graft Disease After Transplantation: A Guide for Liver Biopsy. LB Liver Transpl 2012; 18: 566-576.
Li Z.X, He Y, Wu J, Liang D.M, Zhang B.L, Yang H, et al. Noninvasive evaluation of hepatic fibrosis in children with infant hepatitis syndrome. World J Gastroenterol 2006; 12(44): 7155-7160. Transient Elastography-Based Liver Stiffness
Tokuhara D, Cho Y, Shintaku H. Age-Dependently Increases in Children. PLoS ONE 2016; 11(11): e0166683. doi:10.1371/journal.
Kelly D, Verkade H.J, Rajanayagam J, McKiernan P, Mazariegos G, Hubscher S. Late GraftHepatitis and Fibrosis in Pediatric Liver Allograft Recipients: Current Concepts and Future Developments. Liver Transplantation 2016; 22: 1593–1602.
Foucher J, Chanteloup E, Vergniol J, Caste´ra L, Le Bail B, Adhoute X, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut 2006; 55: 403–408.
Bhat M, Tazari M, Sebastiani G. Performance of transient elastography and serum fibrosis biomarkers for non-invasive evaluation of recurrent fibrosis after liver transplantation: A meta-analysis. PLoS ONE 2017; 12(9): e0185192.
Tomita H, Hoshino K, Fuchimoto Y, Ebinuma H, Ohkuma K, Tanami Y, et al. Acoustic Radiation Force Impulse Imaging for Assessing Graft Fibrosis After Pediatric Living Donor Liver Transplantation: A Pilot Study. LIVER TRANSPLANTATION 2013; 19: 1202–1213.
- Abstract Viewed: 0 times