title: Early non-invasive selection of patients at high risk of severe hepatitis C recurrence after liver transplantation.
abstract: BACKGROUND
  The early identification of patients at high risk of severe post liver transplant hepatitis C recurrence is relevant, as these patients may be treated using interferon (IFN)-free regimens.
  
  
  METHODS
  In a retrospective study with prospectively collected data, we investigated whether the use of several non-invasive methods (fibrosis 4 index [FIB-4], AST-to-platelets ratio index [APRI], enhanced liver fibrosis test [ELF], IFN-γ-inducible protein 10 [IP-10], and transient elastography by Fibroscan) and their combinations 6 months after transplantation could identify those recipients at higher risk of severe recurrence, defined by the presence of significant fibrosis (F ≥2) and/or portal hypertension (hepatic venous pressure gradient ≥6 mmHg) 12 months after transplant. Seventy-two hepatitis C virus (HCV)-infected liver transplant patients and 10 recipients in whom HCV was eradicated before transplantation were included in the study.
  
  
  RESULTS
  The levels of all biomarkers were significantly higher in HCV-infected recipients than in controls. Among HCV recipients, levels of biomarkers were significantly higher in patients with severe recurrence. Although there were no statistically significant differences between biomarkers, APRI, ELF, and FIB-4 obtained the highest area under the ROC curve values. The combination of serum biomarkers with Fibroscan increased the negative and positive predictive values, although diagnostic accuracy of individual tests was not significantly improved.
  
  
  CONCLUSIONS
  Patients at higher risk of severe HCV recurrence can be identified early, 6 months after transplantation, using readily available non-invasive methods.
authors.affiliation: Liver Unit, Hospital Clinic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Crespo
authors.affiliation: Liver Unit, Hospital Clinic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Gambato
authors.affiliation: Department of Biochemistry and Molecular Genetics, Hospital Clinic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Millán
authors.affiliation: Department of Biochemistry and Molecular Genetics, Hospital Clinic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Casals
authors.affiliation: Liver Unit, Hospital Clinic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Ruiz
authors.affiliation: Liver Unit, Hospital Clinic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain.
authors.forename: M C
authors.initials: MC
authors.lastname: Londoño
authors.affiliation: Department of Biochemistry and Molecular Genetics, Hospital Clinic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Mira
authors.affiliation: Liver Unit, Hospital Clinic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Forns
authors.affiliation: Department of Biochemistry and Molecular Genetics, Hospital Clinic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Brunet
authors.affiliation: Department of Biochemistry and Molecular Genetics, Hospital Clinic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain.
authors.forename: W
authors.initials: W
authors.lastname: Jiménez
authors.affiliation: Liver Unit, Hospital Clinic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Navasa
mesh_terms: D000368:Aged; D000465:Algorithms; D000998:Antiviral Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification*; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers
keywords: APRI; ELF; FIB-4; Fibroscan; IP-10; hepatitis C recurrence; liver transplant