title: Role of AST to platelet ratio index in the detection of liver fibrosis in patients with recurrent hepatitis C after liver transplantation.
abstract: OBJECTIVE
  Per protocol annual liver biopsy represents the gold standard in the assessment of graft fibrosis progression due to recurrent hepatitis C after liver transplantation. Non-invasive liver fibrosis tests have been proposed as surrogate markers of liver fibrosis in hepatitis C virus (HCV)-positive immune-competent patients. No data are available in the literature on the usefulness of non-invasive liver fibrosis tests in liver transplanted patients with recurrent HCV infection.
  
  
  METHODS
  A total of 102 annual per protocol liver biopsies performed in 51 consecutive HCV-positive recipients (31 men), with a follow-up period lasting up to 5 years, were included and evaluated in this study. At each time point, the following non-invasive liver fibrosis tests were calculated: aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio, age-platelet index, AST to platelet ratio index (APRI), Forns' fibrosis index and Bonacini's discriminant score.
  
  
  RESULTS
  In discriminating patients with histological fibrosis score >2, APRI provided the best area under the receiver operating characteristic curves (AUROC) (0.801), in comparison to the other four non-invasive liver fibrosis tests. The AUROC of APRI was better in female (0.871) than in male (0.753) recipients. Among female recipients, an APRI value >1.4 was 91% sensitive and 75% specific in detecting a staging score >2. The corresponding values among male recipients were 60% and 77%, respectively.
  
  
  CONCLUSIONS
  Among non-invasive liver fibrosis tests, APRI has the highest diagnostic value in discriminating liver transplanted patients with progression to significant liver fibrosis, although its accuracy is influenced by recipient sex.
authors.affiliation: DPMSC, Medical Liver Transplant Unit, University of Udine, Udine, Italy. pierluigi.toniutto@uniud.it
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Toniutto
authors.forename: Carlo
authors.initials: C
authors.lastname: Fabris
authors.forename: Davide
authors.initials: D
authors.lastname: Bitetto
authors.forename: Edmondo
authors.initials: E
authors.lastname: Falleti
authors.forename: Claudio
authors.initials: C
authors.lastname: Avellini
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Rossi
authors.forename: Carlo
authors.initials: C
authors.lastname: Smirne
authors.forename: Rosalba
authors.initials: R
authors.lastname: Minisini
authors.forename: Mario
authors.initials: M
authors.lastname: Pirisi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D004796:Clinical Enzyme Tests; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery / Q000821:virology; D008111:Liver Function Tests / Q000379:methods*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase