Liver Unit, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Barcelona, Spain.
Am J Transplant. 2014 Feb;14(2):375-83. doi: 10.1111/ajt.12594. Epub 2014 Jan 10.
The value of transient elastography (TE) to assess clinical outcomes in hepatitis C recurrence after liver transplantation (LT) has not been explored so far. We studied 144 hepatitis C-infected and 48 non-hepatitis C virus (HCV)-infected LT recipients and evaluated the prognostic value of TE 1 year after transplantation to predict clinical decompensations and graft and patient survival. In HCV patients, cumulative probabilities of liver decompensation 5 years after LT were 8% for patients with liver stiffness measurement (LSM) <8.7 kilopascals (kPa) versus 47% for patients with LSM ≥ 8.7 kPa (p<0.001). Five-year graft and patient cumulative survival were 90% and 92% in patients with LSM<8.7 kPa (p<0.001) and 63% and 64% in patients with LSM ≥ 8.7 kPa, respectively (p<0.001). Patients with low LSM 1 year after LT had excellent outcomes independently from receiving antiviral treatment or achieving sustained virological response (SVR). In contrast, graft survival significantly improved in patients with LSM ≥ 8.7 kPa who achieved SVR. No association between outcomes and LSM at 12 months was observed in non-HCV patients. In conclusion, LSM 1 year after LT is a valuable tool to predict hepatitis C-related outcomes in recurrent hepatitis C and can be used in clinical practice to identify the best candidates for antiviral therapy.
瞬时弹性成像（TE）在评估肝移植（LT）后丙型肝炎复发的临床结局方面的价值尚未得到探索。我们研究了 144 例丙型肝炎感染和 48 例非丙型肝炎病毒（HCV）感染的 LT 受者，并评估了移植后 1 年 TE 的预后价值，以预测临床失代偿和移植物及患者的存活率。在丙型肝炎患者中，LT 后 5 年肝脏失代偿的累积概率为 LSM<8.7 千帕（kPa）的患者为 8%，而 LSM≥8.7 kPa 的患者为 47%（p<0.001）。LSM<8.7 kPa 的患者 5 年移植物和患者累积存活率分别为 90%和 92%（p<0.001），而 LSM≥8.7 kPa 的患者分别为 63%和 64%（p<0.001）。LT 后 1 年 LSM 低的患者无论是否接受抗病毒治疗或获得持续病毒学应答（SVR），均有良好的预后。相比之下，获得 SVR 的 LSM≥8.7 kPa 的患者，移植物存活率显著提高。在非 HCV 患者中，未观察到结局与 12 个月 LSM 之间存在关联。总之，LT 后 1 年的 LSM 是预测丙型肝炎复发相关结局的有价值的工具，可用于临床实践，以确定抗病毒治疗的最佳候选者。
