Isa Hasan M, Abdulla Mohamed, Abdulla Maryam, Al-Hashimi Hakima, Dunne Kevin, Blackwell James
Pediatric Department, Arabian Gulf University, Manama, Bahrain.
Pediatric Department, Salmaniya Medical Complex, Manama, Bahrain.
Pediatr Transplant. 2025 Aug;29(5):e70120. doi: 10.1111/petr.70120.
Liver biopsy is the gold standard for assessing liver allograft fibrosis but is invasive and carries risks, especially in pediatric liver transplant (PLT) recipients. Two-dimensional shear wave elastography (2D-SWE) has emerged as a promising noninvasive alternative. This study aimed to assess 2D-SWE in evaluating children post-liver transplantation (LTx) and to identify clinical and laboratory predictors of liver stiffness.
In this prospective case-control study, 20 PLT recipients and 20 healthy age- and sex-matched controls were imaged using a GE LOGIQ E10 scanner. Median stiffness, interquartile range (IQR), and IQR/median ratio were calculated based on 12 liver stiffness measurements (LSM). Comparisons between LTx recipients and controls were conducted to determine differences in LSM. A 5.96 kPa cut-off was used to define elevated LSM. Additionally, associations between liver stiffness and demographic data and laboratory findings were assessed to identify potential predictors.
PLT patients exhibited significantly higher liver stiffness compared to controls. No significant differences were observed in ultrasound-guided attenuation parameter (UGAP) scores between the two groups. 44.4% of PLT recipients were above the 5.96 kPa cut-off. Exploratory analyses did not identify significant clinical or laboratory predictors of increased liver stiffness.
2D-SWE is an effective noninvasive tool for assessing liver stiffness in PLT recipients, demonstrating significantly elevated stiffness compared to healthy controls. Elevated or increasing LSMs may necessitate a liver biopsy, thereby reducing the reliance on routine biopsies as standard protocol. Further studies with larger cohorts are needed to validate SWE cut-off values and explore its longitudinal utility.
肝活检是评估肝移植纤维化的金标准，但具有侵入性且存在风险，尤其是在儿童肝移植（PLT）受者中。二维剪切波弹性成像（2D-SWE）已成为一种有前景的非侵入性替代方法。本研究旨在评估2D-SWE在评估儿童肝移植（LTx）后的情况，并确定肝脏硬度的临床和实验室预测指标。
在这项前瞻性病例对照研究中，使用GE LOGIQ E10扫描仪对20名PLT受者和20名年龄和性别匹配的健康对照者进行成像。基于12次肝脏硬度测量（LSM）计算中位硬度、四分位数间距（IQR）和IQR/中位值比率。对LTx受者和对照者进行比较以确定LSM的差异。采用5.96 kPa的临界值来定义LSM升高。此外，评估肝脏硬度与人口统计学数据和实验室检查结果之间的关联，以确定潜在的预测指标。
与对照组相比，PLT患者的肝脏硬度显著更高。两组之间在超声引导下衰减参数（UGAP）评分方面未观察到显著差异。44.4%的PLT受者高于5.96 kPa的临界值。探索性分析未发现肝脏硬度增加的显著临床或实验室预测指标。
2D-SWE是评估PLT受者肝脏硬度的一种有效非侵入性工具，与健康对照相比，其硬度显著升高。LSM升高或增加可能需要进行肝活检，从而减少对常规活检作为标准方案的依赖。需要进行更大队列的进一步研究来验证SWE临界值并探索其纵向效用。
