title: Routine Laboratory Blood Tests May Diagnose Significant Fibrosis in Liver Transplant Recipients with Chronic Hepatitis C: A 10 Year Experience.
abstract: OBJECTIVE
  The aims of our study were to determine whether routine blood tests, the aspartate aminotransferase (AST) to Platelet Ratio Index (APRI) and Fibrosis 4 (Fib-4) scores, were associated with advanced fibrosis and to create a novel model in liver transplant recipients with chronic hepatitis C virus (HCV).
  
  
  METHODS
  We performed a cross sectional study of patients at The University of California at Los Angeles (UCLA) Medical Center who underwent liver transplantation for HCV. We used linear mixed effects models to analyze association between fibrosis severity and individual biochemical markers and mixed effects logistic regression to construct diagnostic models for advanced fibrosis (METAVIR F3-4). Cross-validation was used to estimate a receiving operator characteristic (ROC) curve for the prediction models and to estimate the area under the curve (AUC).
  
  
  RESULTS
  The mean (± standard deviation [SD]) age of our cohort was 55 (±7.7) years, and almost three quarter were male. The mean (±SD) time from transplant to liver biopsy was 19.9 (±17.1) months. The mean (±SD) APRI and Fib-4 scores were 3 (±12) and 7 (±14), respectively. Increased fibrosis was associated with lower platelet count and alanine aminotransferase (ALT) values and higher total bilirubin and Fib-4 scores. We developed a model that takes into account age, gender, platelet count, ALT, and total bilirubin, and this model outperformed APRI and Fib-4 with an AUC of 0.68 (p < 0.001).
  
  
  CONCLUSIONS
  Our novel prediction model diagnosed the presence of advanced fibrosis more reliably than APRI and Fib-4 scores. This noninvasive calculation may be used clinically to identify liver transplant recipients with HCV with significant liver damage.
authors.affiliation: Departments of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Sheen
authors.affiliation: Departments of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
authors.forename: Heajung
authors.initials: H
authors.lastname: Nguyen
authors.affiliation: Departments of Surgery, University of California at Los Angeles, Los Angeles, California, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Jimenez
authors.affiliation: Departments of Surgery, University of California at Los Angeles, Los Angeles, California, USA.
authors.forename: Vatche
authors.initials: V
authors.lastname: Agopian
authors.affiliation: Departments of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
authors.forename: Sitaram
authors.initials: S
authors.lastname: Vangala
authors.affiliation: Departments of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
authors.forename: David
authors.initials: D
authors.lastname: Elashoff
authors.affiliation: Departments of Medicine, University of California at Los Angeles, Los Angeles, California, USA; Departments of Surgery, University of California at Los Angeles, Los Angeles, California, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
keywords: Hepatic fibrosis; Hepatitis C; Liver transplant