title: Transient elastography predicts fibrosis progression in patients with recurrent hepatitis C after liver transplantation.
abstract: OBJECTIVE
  Transient elastography (TE) allows non-invasive evaluation of the severity of liver disease in patients with chronic hepatitis C. This procedure, however, warrants further validation in the setting of liver transplantation (LT), including patients under follow-up for recurrent hepatitis C.
  
  
  METHODS
  Tertiary referral hospital.
  
  
  METHODS
  95 patients (75 males) transplanted for end-stage liver disease due to hepatitis C virus.
  
  
  METHODS
  Paired liver biopsy (LB) and TE were carried out 6-156 (median, 35) months after LT. 40 patients with recurrent hepatitis C sequentially evaluated 6-21 months apart.
  
  
  METHODS
  Clinical, laboratory and graft histological features influencing TE results.
  
  
  RESULTS
  Median TE values were 7.6 kPa in the 90 patients with a successful TE examination, being 5.6 kPa in the 30 patients with Ishak fibrosis score (S) of 0-1, 7.6 kPa in the 38 with S2-3; 16.7 kPa in the 22 with S4-6, (p < 0.0001). Areas under the ROC curves were 0.85 (95% CI, 0.76 to 0.92) for S > or = 3, 0.90 (95% CI, 0.82 to 0.95) for S > or = 4 with 7.9 and 11.9 kPa optimal TE cut-off (81% and 82% sensitivity, 88% and 94% negative predictive value, respectively). Fibrosis, necroinflammatory activity and higher than 200 IU/l gamma-glutamyl transpeptidase levels independently influenced TE results. During post-LT follow-up, TE results changed in parallel with grading (r = 0.63) and staging (r = 0.71), showing 86% sensitivity and 92% specificity in predicting staging increases.
  
  
  CONCLUSIONS
  TE accurately predicts fibrosis progression in LT patients with recurrent hepatitis C, suggesting that protocol LB might be avoided in patients with improved or stable TE values during follow-up.
authors.affiliation: First Division of Gastroenterology, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via Sforza, 35-20122 Milano, Italy. crigamo@tin.it
authors.forename: C
authors.initials: C
authors.lastname: Rigamonti
authors.forename: M F
authors.initials: MF
authors.lastname: Donato
authors.forename: M
authors.initials: M
authors.lastname: Fraquelli
authors.forename: F
authors.initials: F
authors.lastname: Agnelli
authors.forename: G
authors.initials: G
authors.lastname: Ronchi
authors.forename: G
authors.initials: G
authors.lastname: Casazza
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.forename: M
authors.initials: M
authors.lastname: Colombo
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D018450:Disease Progression; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000150:complications / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012720:Severity of Illness Index