Transient Elastography Offers Non-invasive Diagnostic for Detecting Sever Fibrosis
Researchers from the Mayo Clinic confirm that ultrasound-based transient
elastography (TE) provides excellent diagnostic accuracy for detecting
cirrhosis due to recurrent infection with hepatitis C virus (HCV)
infection following liver transplantation. Findings from the study
published in the March issue of Liver
Transplantation, a journal of the American Association for the
Study of Liver Diseases, suggest that detection of significant fibrosis
is more accurate when comparing patients with chronic HCV of the native
liver.
According to the World Health Organization (WHO), chronic HCV affects up
to 170 million people worldwide and could lead to more severe liver
diseases such as cirrhosis and liver cancer. Experts estimate that on
average 6,000 liver transplants are performed in the U.S. each year.
Medical evidence shows that following liver transplantation recipients
who are HCV RNA-positive at the time of transplantation are at risk of
reinfection with HCV. Moreover, studies have determined that fibrotic
tissue can develop more quickly in the transplanted liver resulting in
rapid progression of cirrhosis and graft failure.
“The current gold standard for determining liver disease severity and
progression is liver biopsy,” explains lead author Dr. Jayant Talwalkar
with the Mayo Clinic in Rochester, Minnesota. “However, biopsy following
liver transplantation may not accurately determine fibrosis severity and
non-invasive imaging technology has advanced to more accurately assess
the severity of liver injury which includes an indirect assessment of
elevated portal pressure.” A prior study reported liver biopsy can
understage cirrhosis in up to 30% of cases.
For the present study researchers reviewed studies of the diagnostic
accuracy of ultrasound-based TE, a non-invasive technology used to
assess fibrosis by measuring liver stiffness. The team analyzed the
performance of TE compared to liver biopsy in detecting sever hepatic
fibrosis caused by recurrent HCV post-transplantation. Compared to liver
biopsy, TE is a reproducible diagnostic technique that is quick and
painless for patients.
Six studies were identified, with five studies that evaluated
significant fibrosis and cirrhosis. Analysis of the pooled estimates
showed TE had a sensitivity and specificity of 83%, respectively for
detecting fibrosis. Of the five studies analyzing TE for detecting
cirrhosis, sensitivity estimates were 98% and specificity at 84%.
“Ultrasound-based TE provides excellent diagnostic accuracy for
identifying cirrhosis caused by recurrent HCV following liver
transplantation,” concludes Dr. Talwalkar. “Further studies that confirm
our results could highlight the importance of TE as a diagnostic tool
for liver transplant recipients infected with HCV.”
