Liver Transpl. 2022 Aug 29. doi: 10.1002/lt.26568. Online ahead of print.
ABSTRACT
Combining bio-clinical parameters with liver stiffness measurement (LSM) has improved the diagnostic performance of vibration controlled transient elastography (VCTE) for detection of advanced fibrosis in patients with chronic liver disease. However, this approach has not yet been tested in liver transplant (LT) recipients. Thus, the aim of the current study was to evaluate the diagnostic performance of combining LSM-based scores to LSM alone for detection of advanced fibrosis in LT recipients.
METHOD: Adult LT recipients with a liver biopsy, VCTE and clinical data necessary to construct LSM-based fibrosis models (FAST, Agile 3+ and Agile 4) were included (N=132). The diagnostic statistics advanced fibrosis [fibrosis stage 0-2 vs. 3-4] were determined using optimal cut-off using Youden index.
RESULTS: The area under the receiver operator curve (AUROC) [95% CI] for LSM was 0.94 [0.89, 0.99], FAST was 0.65 [0.50, 0.79], Agile 3+ was 0.90 [0.83, 0.97], and Agile 4 was 0.90 [0.83, 0.97]. No statistically significant differences were noted between the AUROC of LSM vs. LSM-based scores. The false positive rates for Agile 3+ and Agile 4 was 14.5% and 11.8% compared to 8.3% for LSM alone. The false positive rates in LSM-based scores were higher among patients with diabetes, higher AST levels and lower platelet counts.
CONCLUSION: The LSM based scores do not improve the diagnostic performance of LSM alone in LT recipients for detection of advanced fibrosis. This results from the impact of immunosuppression on bio-clinical profile and underscores the importance of developing LSM-based scores that are specific to LT patients.
PMID:36036790 | DOI:10.1002/lt.26568
