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| |  Liver Stiffness Measurements Identify Patients With Rapid or Slow Fibrosis HOBOKEN, NJ -- January 5, 2010 -- A study published in the January 2010 issue of the journal Hepatology determined that repeated liver stiffness measurements (LSM) in the first year following liver transplant (LT) could discriminate between slow and rapid fibrosers (stage F2-F4) 1 year post transplant. Liver stiffness measurements were extremely accurate, particularly at the 6-month post LT point, in detecting severity of fibrosis. Determining those at risk for a recurrence of hepatitis C virus (HCV) allows for early-stage administration of therapies that could prevent liver transplant or graft failure. From August 2004 to January 2008, 84 liver transplant recipients with HCV recurrence and 19 patients transplanted for reasons other than HCV were included in the study. The cause of liver transplant in the non-HCV control group included: alcoholic cirrhosis (n = 10), primary biliary cirrhosis (n = 2), Caroli’s disease (n = 2), familial amyloid polyneuropathy (n = 2), autoimmune hepatitis (n = 1), and cryptogenetic cirrhosis (n = 2). Liver stiffness was measured using Fibroscan on the right lobe of the liver with repeated measurements during the first year after transplant. Results indicated that LSM did not significantly increase during the first year after liver transplantation for all control participants. There were 53 patients deemed slow fibrosers with median LSM at 3, 6, 9, and 12 months at 6.9, 6.9, 7.5, and 6.6 kilopascals, respectively, without significant increase during the follow-up year. The remaining 31 participants were rapid fibrosers who had median LSM at months 3, 6, 9, and 12 of 7.5, 9.9, 9.5 and 12.1 kilopascals, respectively. “Our study clearly shows 2 different speeds of liver fibrosis progression during the first year after liver transplantation,” said lead author Miquel Navasa, MD, Hospital Clínic, Barcelona, Spain. “Slow fibrosers progressed at the same rate as non-HCV liver transplant patients, while rapid fibrosers showed significant fibrosis and portal hypertension very early in the follow-up.” Researchers also conducted univariate and multivariate analyses to identify the variables associated with the presence of significant fibrosis (F>=2) 1 year post transplant. The univariate analysis identified 6 variables associated with rapid fibrosis progression: Cytomegalovirus infection, ALT level, bilirubin level and HCV-viral load (at 3 months), and bilirubin level and LSM (at 6 months). The multivariate analysis showed that only LSM and bilirubin level at 6 months were independent predictors of fibrosis “Using non-invasive detections such as LSM or bilirubin levels at 6 months can accurately predict the risk to develop significant fibrosis in liver transplant recipients,” said Dr. Navasa. “Our results will need to be validated by other transplant centres, but we believe these models could be widely used in clinical practice to adopt appropriate therapeutic interventions at first signs of HCV recurrence.”
SOURCE: Wiley Blackwell
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