title: Noninvasive tests for evaluation of fibrosis in HCV recurrence after liver transplantation: a systematic review.
abstract: Noninvasive tests (NIT) for evaluation of hepatic fibrosis have not been evaluated extensively in liver transplantation. We systematically reviewed the literature regarding NIT after liver transplantation. We identified 14 studies evaluating NIT based on serum markers and/or liver imaging techniques: 10 studies assessed NIT in recipients with recurrent HCV infection for fibrosis and four studies evaluated predictors of progression of fibrosis in recurrent HCV. Transient Elastography (TE) had good discrimination for significant fibrosis (median AUROC: 0.88). Among the serum NIT, APRI had good performance (median AUROC: 0.75). TE performed better than serum (direct and indirect) NIT for significant fibrosis with median AUROC 0.88 (vs. 0.66, P < 0.001), median sensitivity 0.86 (vs. 0.56, P = 0.002), median NPV 0.90 (vs. 0.74, P = 0.05) and median PPV 0.80 (vs. 0.63, P = 0.02). TE compared to indirect serum NIT, had better performance, but was not superior to APRI score. Finally, direct, compared to indirect NIT, were not significantly different except for specificity: median: 0.83 vs. 0.69, respectively, P = 0.04. In conclusion, NIT could become an important tool in clinical management of liver transplant recipients, but whether they can improve clinical practice needs further evidence. Their optimal combination with liver biopsy and assessment of collagen content requires investigation.
authors: The 4th Department of Internal Medicine, Medical School of Aristotle University, Greece. Royal Free Hospital, London, UK.
authors: Evangelos
authors: E
authors: Cholongitas
authors: Emmanouel
authors: E
authors: Tsochatzis
authors: John
authors: J
authors: Goulis
authors: Andrew K
authors: AK
authors: Burroughs
mesh_terms: D003094:Collagen / Q000032:analysis; D054459:Elasticity Imaging Techniques; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology; D008111:Liver Function Tests / Q000379:methods*; D016031:Liver Transplantation; D012008:Recurrence; D015203:Reproducibility of Results
chemical_list: D003094:Collagen