title: AST-to-platelet ratio index in non-invasive assessment of long-term graft fibrosis following pediatric liver transplantation.
abstract: Long-term graft fibrosis occurs in the majority of pediatric liver transplant recipients. Serial biopsies to monitor graft health are impractical and invasive. The APRI has been evaluated in pediatric liver disease, but not in the context of post-transplantation fibrosis. We aimed to investigate the validity of APRI as a predictor of long-term graft fibrosis in pediatric liver transplant recipients. This was a retrospective, observational study of a cohort of children who underwent liver transplantation at King's College Hospital between 1989 and 2003, with a relevant dataset available. Protocol liver biopsies were performed at 10-yr follow-up and fibrosis was graded using the Ishak scoring system, with S3-6 denoting "significant fibrosis." APRI was calculated concurrently with biopsy. A total of 39 asymptomatic patients (20 males; median age at transplant, 1.43 yr) underwent protocol liver biopsies at a median of 10.39 yr post-transplantation. APRI was associated with significant fibrosis (p = 0.012). AUROC for APRI as a predictor of significant fibrosis was 0.74 (p = 0.013). The optimal cutoff APRI value for significant fibrosis was 0.45 (sensitivity = 0.67; specificity = 0.79; PPV = 0.67; NPV = 0.79). APRI appears to be a useful non-invasive adjunct in the assessment of significant graft fibrosis in the long-term follow-up of pediatric liver transplant survivors.
authors.affiliation: King's College London School of Medicine, London, UK.
authors.forename: Rashmi S
authors.initials: RS
authors.lastname: D'Souza
authors.affiliation: Institute of Liver Studies, King's College London School of Medicine, London, UK.
authors.forename: Lara
authors.initials: L
authors.lastname: Neves Souza
authors.affiliation: King's College London School of Medicine, London, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Isted
authors.affiliation: King's College London School of Medicine, London, UK.|Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK.
authors.forename: Emer
authors.initials: E
authors.lastname: Fitzpatrick
authors.affiliation: King's College London School of Medicine, London, UK.|Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK.
authors.forename: Sunitha
authors.initials: S
authors.lastname: Vimalesvaran
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: Corina
authors.initials: C
authors.lastname: Cotoi
authors.affiliation: Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK.
authors.forename: Saista
authors.initials: S
authors.lastname: Amin
authors.affiliation: Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Heaton
authors.affiliation: King's College London School of Medicine, London, UK.|Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: Alberto
authors.initials: A
authors.lastname: Quaglia
authors.affiliation: King's College London School of Medicine, London, UK.|Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK.
authors.forename: Anil
authors.initials: A
authors.lastname: Dhawan
mesh_terms: D000367:Age Factors; D001219:Aspartate Aminotransferases / Q000097:blood*; D001706:Biopsy; D001792:Blood Platelets / Q000166:cytology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology*; D017093:Liver Failure / Q000097:blood / Q000601:surgery; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D010976:Platelet Count; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D001219:Aspartate Aminotransferases
keywords: aminotransferase-to-platelet ratio index; non-invasive prediction; significant fibrosis