Lee Christine K, Nastasio Silvia, Mitchell Paul D, Fawaz Rima, Elisofon Scott A, Vakili Khashayar, Kim Heung Bae, Nguyen Denis, Jonas Maureen M
Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA.
Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA.
Pediatr Transplant. 2020 Sep;24(6):e13736. doi: 10.1111/petr.13736. Epub 2020 May 20.
TE measures liver stiffness to assess fibrosis. Its use in post-transplant patients was reported in few small pediatric studies. We evaluated TE ability to predict liver graft fibrosis in a large cohort while comparing it to the performance of APRI and FIB-4. We also investigated the effect of graft type on LSMs. Patients at Boston Children's Hospital who underwent LT and LSM ≤ 1 year from biopsy (2007-2018) were eligible. Ninety-four patients (45%M) aged 1-21 years (89% < 18 years; 13% < 2 years) were eligible. Median time between transplant/biopsy and LSM was 5.1 years and 52 days, respectively. Thirty-nine percent received whole-liver grafts, 54% TV grafts, and 6% as part of MV. At LSM, median ALT was 25 [IQR 16-33] IU/L. Twenty-one percent had METAVIR ≥ F2. LSM was statistically higher among those with significant fibrosis (METAVIR ≥ F2) compared to those with METAVIR F0/F1 (median [IQR] 7.5 [4.6, 13.6] vs 5.1 [4.0, 6.4] kPa, respectively) (P = .005 by Wilcoxon rank-sum test). APRI and FIB-4 distributions were not different across METAVIR stages. The AUROC for LSM was 0.71 (95% CI 0.56-0.85) with an optimal cut-point of 6.5 kPa. Graft type had no influence on the AUROC for LSM. TE is useful for assessing significant graft fibrosis in children and young adult LT recipients and performs better than APRI and FIB-4. TV grafts demonstrate similar correlation with histology as whole-liver grafts.
瞬态弹性成像（TE）测量肝脏硬度以评估肝纤维化。少数小型儿科研究报道了其在肝移植术后患者中的应用。我们在一个大型队列中评估了TE预测肝移植肝纤维化的能力，并将其与天冬氨酸氨基转移酶与血小板比值指数（APRI）和FIB-4的表现进行比较。我们还研究了移植物类型对肝脏硬度测量值（LSM）的影响。波士顿儿童医院中接受肝移植且活检后LSM≤1年（2007 - 2018年）的患者符合条件。94名患者（45%为男性），年龄1至21岁（89%＜18岁；13%＜2岁）符合条件。移植/活检与LSM之间的中位时间分别为5.1年和52天。39%接受全肝移植，54%接受劈离式肝移植，6%接受多脏器移植中的肝脏移植部分。在LSM时，谷丙转氨酶（ALT）中位数为25[四分位间距（IQR）16 - 33]IU/L。21%的患者梅塔维（METAVIR）纤维化分期≥F2。与METAVIR F0/F1期患者相比，显著纤维化（METAVIR≥F2）患者的LSM在统计学上更高（中位数[IQR]分别为7.5[4.6, 13.6]与5.1[4.0, 6.4]kPa）（威尔科克森秩和检验，P = 0.005）。APRI和FIB-4的分布在不同METAVIR分期中无差异。LSM的受试者工作特征曲线下面积（AUROC）为0.71（95%置信区间0.56 - 0.85），最佳切点为6.5kPa。移植物类型对LSM的AUROC无影响。TE有助于评估儿童和年轻成人肝移植受者的显著移植物纤维化，且表现优于APRI和FIB-4。劈离式肝移植与全肝移植在与组织学的相关性方面表现相似。
