Assessment of Allograft Fibrosis by Transient Elastography and Noninvasive Biomarker Scoring Systems in Liver Transplant Patients

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This prospective, monocentric study was designed to assess the efficacy of transient elastography (TE), biochemical tests, and more complex scores in determining fibrosis stage in 157 patients transplanted for hepatitis C virus (HCV) infection or non–HCV-related liver diseases.

Methods and Results.

The optimal TE cutoff values for HCV patients and non-HCV patients were 4.7 and 5.0 kPa for F≥1, 7.1 and 7.3 kPa for F≥2, 10.9 kPa and 9.9 kPa for F≥3, and 17.3 and 12.6 kPa for F=4, respectively. The corresponding area under the receiver operating characteristic (AUROC) curves for F≥1, F≥2, F≥3, and F=4 were 0.95 and 0.86, 0.89 and 0.85, 0.97 and 0.88, and 0.99 and 0.97 for HCV and non-HCV patients, respectively. On the basis of the logistic regression equation, we created a model (FibroTransplant score) to identify advanced fibrosis (F≥3). The accuracy of this model was tested in a validation group (n=74). AUROCs for diagnosis of F≥3 in HCV patients and non-HCV patients of the training group were 0.89 and 0.83 (FibroTransplant score), 0.86 and 0.66 (Benlloch score), 0.81 and 0.71 (aspartate aminotransferase-to-platelet ratio index), 0.80 and 0.77 (Hepascore), 0.79 and 0.70 (FibroTest), 0.78 and 0.71 (FIB-4), 0.75 and 0.60 (Forns index), 0.73 and 0.69 (FibroIndex), and 0.70 and 0.59 (Lok score). Among the validation group, AUROCs of the FibroTransplant score for F≥3 were 0.90 and 0.91, respectively.


TE and the FibroTransplant score can be reliably used for diagnosing advanced fibrosis in transplanted patients.

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