Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Liver Transpl. 2013 Nov;19(11):1202-13. doi: 10.1002/lt.23708. Epub 2013 Sep 21.
Graft fibrosis is a common finding during protocol biopsy examinations after pediatric liver transplantation. We evaluated the clinical utility of liver stiffness measurements by acoustic radiation force impulse (ARFI) imaging, a novel ultrasound-based elastography method, for assessing graft fibrosis after pediatric living donor liver transplantation (LDLT). We performed 73 liver stiffness measurements by ARFI imaging in 65 pediatric LDLT recipients through the upper midline of the abdomen (midline value) and the right intercostal space (intercostal value) around the time of protocol biopsy examinations. Fifty-nine of these liver stiffness measurements could be compared with histopathological findings. Graft fibrosis was assessed according to the degrees of portal and pericellular fibrosis. Significant fibrosis, which was defined as F2 or worse portal fibrosis and/or moderate or worse pericellular fibrosis, was observed in 14 examinations, which had significantly higher midline (P = 0.005) and intercostal values (P < 0.001) than the others. Liver stiffness measurements by ARFI imaging significantly increased with increases in the portal and pericellular fibrosis grades. For the diagnosis of significant fibrosis, the areas under the receiver operating characteristic curve (AUROCs) were 0.760 (P = 0.005) and 0.849 (P < 0.001) for the midline and intercostal values, respectively. The optimal cutoff values were 1.30 and 1.39 m/second for midline and intercostal values, respectively. Slight but significant elevations were noted in the results of biochemical liver tests: serum levels of γ-glutamyltransferase showed the highest AUROC (0.809, P = 0.001) with an optimal cutoff value of 20 IU/L. In conclusion, liver stiffness measurements by ARFI imaging had good accuracy for diagnosing graft fibrosis after pediatric LDLT. The pericellular pattern of fibrosis was frequently observed after pediatric LDLT, and moderate pericellular fibrosis was detectable by ARFI imaging.
移植肝纤维化是小儿肝移植术后临床肝活检的常见表现。我们评估了声辐射力脉冲（ARFI）成像技术（一种新型的超声弹性成像方法）测量肝硬度在评估小儿活体肝移植（LDLT）后肝纤维化中的临床应用。我们对 65 名小儿 LDLT 受者通过腹部中线（中线值）和肋间隙（肋间隙值）进行了 73 次 ARFI 成像肝硬度测量，这些测量时间都接近临床肝活检。其中 59 次肝硬度测量可与组织病理学发现进行比较。根据门脉和细胞周围纤维化的程度评估移植肝纤维化。14 次肝活检显示有显著纤维化（定义为 F2 及以上门脉纤维化和/或中度及以上细胞周围纤维化），其中线（P = 0.005）和肋间隙值（P < 0.001）明显高于其他检查。ARFI 成像肝硬度测量值随着门脉和细胞周围纤维化程度的增加而显著增加。对于显著纤维化的诊断，中线和肋间隙值的受试者工作特征曲线（AUROCs）面积分别为 0.760（P = 0.005）和 0.849（P < 0.001）。中线和肋间隙值的最佳截断值分别为 1.30 和 1.39 m/s。生化肝功能检查结果略有升高：γ-谷氨酰转移酶（γ-GT）水平的 AUROC 最高（0.809，P = 0.001），最佳截断值为 20 IU/L。总之，ARFI 成像测量肝硬度对小儿 LDLT 后肝纤维化的诊断具有良好的准确性。小儿 LDLT 后常观察到细胞周围纤维化模式，中度细胞周围纤维化可通过 ARFI 成像检测到。
