Validation of the FIB-4 index for evaluation of fibrosis in patients with recurrent hepatitis C after living donor liver transplantation: A single center experience

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The FIB-4 index has been proposed as a simple, non-invasive surrogate marker of liver fibrosis in patients with hepatitis C virus (HCV). However, the utility of FIB-4 in HCV positive patients after living donor liver transplantation (LDLT) has not been assessed. The aim of this study was to evaluate the efficacy of FIB-4 in the detection of significant liver graft fibrosis caused by recurrent HCV infection after LDLT compared with other simple fibrosis markers.


A total of 259 liver biopsies (LB) with evidence of recurrent HCV were taken from 110 HCV positive LDLT patients who had undergone concomitant splenectomy before administration of antiviral therapy. In LB performed at 3 months or later after LT (n = 202, subject group), FIB-4 was compared between fibrosis stages and the accuracy of FIB-4 in predicting significant fibrosis (METAVIR, F ≥ 2) was assessed compared with aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio, age–platelet index, and AST to platelet ratio index (APRI).


FIB-4 was significantly different between all fibrosis stages (F0 and F1–F4, P = 0.022; F0/1 and F2–F4, P < 0.0005; and F0–F2 and F3F4, P = 0.034) and provided the best area under the receiver–operator curve (AUROC) compared with other markers (FIB-4, 0.711; APRI, 0.693; age–platelet index, 0.663; and AST to ALT ratio, 0.562). The optimal cut-off value to identify significant fibrosis was 2.20 with 65% sensitivity and 69% specificity.


FIB-4 is a more reliable marker for diagnosing significant liver fibrosis than APRI, age–platelet index, and AST to ALT ratio in LDLT patients with HCV.

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