title: Can aminotransferase-to-platelet ratio index and other non-invasive markers effectively reduce liver biopsies for renal transplant evaluation of hepatitis C virus-positive patients?
abstract: BACKGROUND
  Advanced fibrosis or cirrhosis is still regarded as a contraindication for kidney transplantation alone by most centers. The value of aminotransferase to platelet ratio index (APRI) and other non-invasive markers has been less studied in hepatitis C virus (HCV)-positive patients with concurrent end-stage renal disease to predict hepatic fibrosis. Can these be used to effectively decrease the number of biopsies done in these patients being evaluated for transplantation?
  
  
  METHODS
  Our study population included 255 patients with liver biopsy data. All patient information was collected and reviewed from medical records. The diagnostic accuracy of the predictive models was analyzed by calculating sensitivity, specificity, positive predictive value and negative predictive value.
  
  
  RESULTS
  The variables associated with F3-F4 were aspartate aminotransferase (P = 0.007), bilirubin (P ≤ 0.001), platelet count (P = 0.01) and APRI (P ≤ 0.001). The use of any one laboratory abnormality to predict liver biopsy scores did not show high positive predictive values (22.6-72.7%). Having abnormal liver findings or cirrhosis on imaging was associated with high specificities (92.0-97.8%) but low sensitivities (31.4-42.9%). Using APRI levels of ≥0.40 and ≤0.95 as an indication for liver biopsy, 50% of patients with F3-F4 would have correctly avoided having a biopsy. However, 33% of patients with F3-F4 would have been mislabeled and not be indicated for biopsy.
  
  
  CONCLUSIONS
  Our data suggest that there may not currently be a simple and sufficiently accurate non-invasive test to replace liver biopsy in renal transplant workup for HCV-positive patients. The risks outweigh the benefits when it comes to using non-invasive markers like the APRI.
authors.affiliation: Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Edmund
authors.initials: E
authors.lastname: Huang
authors.affiliation: Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mehrnia
authors.affiliation: Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Mandana
authors.initials: M
authors.lastname: Kamgar
authors.affiliation: Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Phuong T
authors.initials: PT
authors.lastname: Pham
authors.affiliation: Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Olaoluwapo
authors.initials: O
authors.lastname: Ogunorunyinka
authors.affiliation: Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Isaiah
authors.initials: I
authors.lastname: Brown
authors.affiliation: Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Danovitch
authors.affiliation: Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Suphamai
authors.initials: S
authors.lastname: Bunnapradist
mesh_terms: D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood*; D001663:Bilirubin / Q000097:blood; D001706:Biopsy; D000075202:Contraindications; D005260:Female; D016174:Hepacivirus / Q000276:immunology; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D001219:Aspartate Aminotransferases; D001663:Bilirubin
keywords: hepatitis c; liver fibrosis; non-invasive markers; renal transplant