STEATOSIS AND LIVER FIBROSIS ASSESMENT IN LIVER TRANSPLANT RECIPIENTS – THE USE OF NONINVASIVE SCORING SYSTEMS IN CLINICAL PRACTICE

Carmen Ester1, Speranta Iacob1, Corina Pietrareanu1, Razvan Cerban1, Mihaela Lita1, Doina Hrehoret1, Vladislav Brasoveanu1, Irinel Popescu1, Liliana Pislaru1, Georgiana Constantin1, Liana Gheorghe1

1Center for digestive diseases and liver transplantation, Fundeni Clinical Institute, Bucharest, Romania

Background and aims: Various combinations and algorithms of potential serum biomarkers have been used in NAFLD (non-alcoholic fatty liver disease) mainly for distinguishing advanced fibrosis. The aim of this study was to evaluate the use of non-invasive scoring tests in clinical practice in liver transplant recipients for identifying NAFLD/NASH (non-alcoholic steatohepatitis) or advanced fibrosis.

Methods: We included in this study 60 liver transplant recipients who were evaluated with clinical and serum biological markers. Fibroscan with CAP (controlled attenuation parameter) was performed for all patients. The statistical analysis was performed using multiple regression analysis and Spearman’s rank correlation test.

Results: Our study population consisted of 20 females (33.3%) and 40 males (66.6%), a median age at evaluation 58 years and a median time since transplantation of 35.03 months.

Independent risk factors for steatosis grade III identified by transient elastography with CAP in liver transplant recipients were: higher BMI (p=0.0004), higher thoracic perimeter (p=0.0004) and higher glycaemia (p=0.01). No noninvasive score for NAFLD evaluation correlated with CAP value. However, liver stiffness correlated with the following noninvasive scores: APRI (r=0.41, p=0.004), GUCI (r=0.43, p=0.002), Bonacini (r=0.26, p=0.04) and King (r=0.38, p=0.008), but not with FIB-4, FIBRO-Q, BARD, NAFLD score or Lok score. In HCV liver transplant recipients the following noninvasive scores for fibrosis evaluation were significantly different compared to patients without HCV infection: BARD score (2.1±0.2 vs 1.3±0.2, p=0.02), NAFLD score (-0.6

±0.2 vs -1.6±0.3, p=0.04), Bonacini (5.1±0.2 vs 4.1±0.4, p=0.04), but not APRI, FIB-4, FIBRO-Q, GUCI, King, Lok score.

Conclusions: Although the noninvasive diagnosis of NASH is still an unmet need, especially in post transplant setting, risk stratification is possible with simple, non-invasive tests consisting of laboratory and clinical indices. HCV recipients have a higher risk of NASH related fibrosis compared to other diseases.

Key words: NAFLD/NASH, liver fibrosis, liver transplant

STEATOFIBROZA POST TRANSPLANT HEPATIC – ROLUL SCORURILOR NON-INVAZIVE IN PRACTICA CLINICA

Carmen Ester1, Speranta Iacob1, Corina Pietrareanu1, Razvan Cerban1, Mihaela Lita1, Doina Hrehoret1, Vladislav Brasoveanu1, Irinel Popescu1, Liliana Pislaru1, Georgiana Constantin1, Liana Gheorghe1

1Centrul pentru boli digestive si transplant hepatic, Institutul Clinic Fundeni, Bucuresti, Romania

Introducere: Biomarkerii serici au fost utilizati in NAFLD (non-alcoholic fatty liver disease) in special pentru a distinge fibroza avansată. Scopul acestui studiu a fost de a evalua utilitatea testelor noninvazive în practica clinică la pacienții transplantati hepatic pentru identificarea NAFLD/NASH (steatohepatita nealcoolică) sau fibroza avansată.

Metode: Am inclus 60 de pacienți transplantati hepatic care au fost evaluati prin markeri biologici si clinici. Fibroscan cu CAP (parametrul de atenuare controlată) a fost efectuat pentru toți pacienții. Analiza statistică a fost realizată folosind analiza de regresie multiplă și testul de corelație Spearman.

Rezultate: Studiul include 33,3%femei, o vârstă medie de 58 de ani la evaluare și un timp mediu de la transplant de 35 luni. Factorii de risc independenți pentru steatoza grad III identificata prin CAP au fost: indicele de masa corporala crescut (p = 0,0004), perimetrul toracic crescut (p = 0,0004) și glicemia crescuta (p = 0,01). Niciun scor noninvaziv pentru NAFLD nu s-a corelat cu valoarea CAP. Rigiditatea hepaticas-a corelat cu următoarele scoruri: APRI (r = 0,41, p = 0,004), Guci (r = 0,43, p = 0,002), Bonacini (r = 0,26, p = 0,04) și King (r = 0,38, p = 0,008), dar nu și cu FIB-4, FIBRO-Q, Bard, NAFLD sau Lok. La paciențiicu VHC următoarele scoruri au fost semnificativ diferite comparativ cu pacienții fără infecție cu VHC: Bard (2,1 ± 0,2 vs 1,3 ± 0,2, p = 0,02), NAFLD (-0.6± 0,2 vs -1.6 ± 0,3, p = 0,04), Bonacini (5,1 ± 0,2 vs 4,1 ± 0,4, p = 0,04), dar nu și APRI, FIB-4, FIBRO-Q, Guci, King sau Lok.

Concluzii: Desi diagnosticul noninvaziv al NASH este deocamdata o cerinta neindeplinita, în special in contextul transplantului hepatic, stratificarea riscului este posibila utilizand teste simple, noninvazive. Pacientii cu VHC au un risc mai mare de fibroză asociata NASH comparativ cu alte etiologii.

Cuvinte cheie: NAFLD/NASH, fibroza hepatica, transplant hepatic