title: A simple, noninvasive test for the diagnosis of liver fibrosis in patients with hepatitis C recurrence after liver transplantation.
abstract: Recurrent hepatitis C is a common cause of graft loss in patients undergoing liver transplantation, and serial protocol liver biopsies have been used to identify patients at risk of graft loss from rapid fibrosis progression. The aim of this study was to derive a simple noninvasive index to predict fibrosis in patients with recurrent hepatitis C post-transplant. A retrospective study was performed assessing serial liver biopsies for post-transplant chronic hepatitis C infection. One hundred eighty-five patients were included in the analysis; median age 53 years (interquartile range 48-59) and 140 (76%) were male. Liver histology showed 53 (29%) had Ishak fibrosis stages F0/F1, 31 (17%) had F2, 29 (16%) had F3, 19 (10%) had F4 and 53 (29%) had F5/F6. The London Transplant Centres' (LTC) score was derived combining aspartate aminotransferase (AST IU/L), time from liver transplant (TFLT months), international normalized ratio and platelets. Diagnostic accuracy of the LTC score was assessed using area under receiver-operating characteristic (ROC) curves. The area under the ROC curve for moderate fibrosis (F >or= 2) was 0.78 (95% CI, 0.70-0.86; P < 0.0001), for advanced fibrosis (F4-6) was 0.80 (95% CI, 0.72-0.87; P < 0.0001) and for cirrhosis was 0.80 (95% CI, 0.72-0.88; P < 0.0001). An optimal cut-off value of 6.3 distinguished patients with no or mild fibrosis (F <or= 1) odds ratio 10.8 (95% CI, 5.1-22.9); P < 0.0001), sensitivity 88%, specificity 60%, negative predictive value 67% and positive predictive value 84%. The LTC score can identify patients with Hepatitis C virus recurrence following liver transplant with a low risk of significant fibrosis, thus avoiding the need for protocol biopsy.
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London, UK.
authors.forename: T J S
authors.initials: TJ
authors.lastname: Cross
authors.forename: V
authors.initials: V
authors.lastname: Calvaruso
authors.forename: M R
authors.initials: MR
authors.lastname: Foxton
authors.forename: P
authors.initials: P
authors.lastname: Manousou
authors.forename: A
authors.initials: A
authors.lastname: Quaglia
authors.forename: F
authors.initials: F
authors.lastname: Grillo
authors.forename: A P
authors.initials: AP
authors.lastname: Dhillon
authors.forename: J
authors.initials: J
authors.lastname: Nolan
authors.forename: T P
authors.initials: TP
authors.lastname: Chang
authors.forename: J
authors.initials: J
authors.lastname: O'Grady
authors.forename: M A
authors.initials: MA
authors.lastname: Heneghan
authors.forename: J P
authors.initials: JP
authors.lastname: O'Beirne
authors.forename: A K
authors.initials: AK
authors.lastname: Burroughs
authors.forename: P M
authors.initials: PM
authors.lastname: Harrison
mesh_terms: D001219:Aspartate Aminotransferases / Q000097:blood*; D001706:Biopsy; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis*; D006651:Histocytochemistry; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis*; D016031:Liver Transplantation; D008131:London; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012372:ROC Curve; D012008:Recurrence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D001219:Aspartate Aminotransferases