Assessment of graft fibrosis by transient elastography in patients with recurrent hepatitis C after living donor liver transplantation

Background. Transient elastography (FibroScan) is a simple and noninvasive method to assess liver fibrosis by measuring liver stiffness and therefore can be a promising tool to evaluate liver fibrosis and avoid liver biopsy. We prospectively assessed the performance of transient elastography in patients with recurrent hepatitis C virus after living donor liver transplantation, in comparison with the surrogate serum markers. Methods. Fifty-six patients with recurrent hepatitis C virus after living donor liver transplantation, who under-went both liver biopsy and transient elastography were included in this study. The grade of liver fibrosis (the Scheuer classification) obtained by biopsy was compared to liver stiffness m easured by the transient elastography. Results. The fibrosis grades were as follows: F0, n=22; F1, n = 13; F2, n = 9; F3, n= 7; and F4, n= 5. Liver stiffness values ranged from 2.9 to 72.0 kPa. The optimal cutoff values were 8.8 kPa for F >= 1, 9.9 kPa for F > 2, 15.4 kPa for F >= 3, and 26.5 kPa for F >= 4. The area under the receiver operator characteristic curve for the diagnosis of fibrosis (F >= 2) by transient elastography was 0.92, while that by hyaluronic acid, type 4 collagen, alanine aminotransferase, and the aspartate transaminase to platelets ratio index were 0.52, 0.62, 0.64, and 0.70, respectively. Conclusions. These data suggest that transient elastography is a simple, noninvasive and reliable tool to assess liver fibrosis in patients with recurrent hepatitis C virus after living donor liver transplantation.