title: Novel histologic scoring system for long-term allograft fibrosis after liver transplantation in children.
abstract: The existing systems for scoring fibrosis were not developed to evaluate transplanted livers. Our aim was to design and validate a novel fibrosis scoring system specifically adapted to assess liver allograft fibrosis (LAF). Clinical data, histology, transient elastography (TE) and AST/platelet ratio index (APRI) were reviewed in 38 pediatric liver transplant (LT) recipients. Protocol liver biopsies performed at 6 months and 7 years post-LT were reviewed by three pathologists who assessed LAF using the METAVIR and Ishak systems. LAF was also scored separately in portal (0-3), sinusoidal (0-3) and centrolobular areas (0-3). Scoring evaluations were correlated with fibrosis quantification using morphometry, and also with TE and APRI. Statistical correlations between morphometry and METAVIR were 0.571 (p < 0.000) and 0.566 (p < 0.000) for the Ishak system. The novel score (0-9) for separate assessment of portal, sinusoidal and centrolobular fibrosis showed a better correlation with morphometry (0.731; p < 0.000) and high intra-/interobserver agreement (0.966; p < 0.000 and 0.794; p < 0.000, respectively). No correlation was found between TE or APRI and morphometry or the three histologic scores. In conclusion, this novel semiquantitative fibrosis scoring system seems to more accurately reflect LAF than the existing scoring system and may become a practical tool for staging fibrosis in LT.
authors.affiliation: Pediatric Surgery and Transplant Unit Department of Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. carla.venturi@uclouvain.be
authors.forename: C
authors.initials: C
authors.lastname: Venturi
authors.forename: C
authors.initials: C
authors.lastname: Sempoux
authors.forename: J
authors.initials: J
authors.lastname: Bueno
authors.forename: J C
authors.initials: JC
authors.lastname: Ferreres Pinas
authors.forename: C
authors.initials: C
authors.lastname: Bourdeaux
authors.forename: J
authors.initials: J
authors.lastname: Abarca-Quinones
authors.forename: J
authors.initials: J
authors.lastname: Rahier
authors.forename: R
authors.initials: R
authors.lastname: Reding
mesh_terms: D000293:Adolescent; D001707:Biopsy, Needle; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000473:pathology*; D006085:Graft Survival; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods*; D007223:Infant; D008103:Liver Cirrhosis / Q000473:pathology*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D015588:Observer Variation; D011183:Postoperative Complications / Q000473:pathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D014184:Transplantation, Homologous / Q000473:pathology; D016896:Treatment Outcome