Utilization of Shear Wave Elastography in the Evaluation of Pediatric Liver Transplant: A Prospective Case-Controlled Study.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.