Ultraschall Med 2013; 34 - WS_SL5_01
DOI: 10.1055/s-0033-1354826

Mortality prediction with transient elastography in recurrent-HCV infection after liver transplantation

A Pecorelli 1, F Piscaglia 1, V Salvatore 1, F Corradi 2, S Flori 1, A D'Errico 3, F Vasuri 3, MR Tamè 4, P Andreone 5, A Gianstefani 1, L Bolondi 1
  • 1Policlinico S. Orsola-Malpighi, Università di Bologna, Department of Internal Medicine and Gastroenterology-Division of Internal Medicine, Bolondi, Bologna, Italy
  • 2IRCCS-Azienda Ospedaliera Universitaria-IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy
  • 3Policlinico S. Orsola-Malpighi, Università di Bologna, Division of Pathology, F. Addarii Institute, Department of Oncology and Hematology, Bologna, Italy
  • 4Policlinico S. Orsola-Malpighi, Università di Bologna, Division of Gastroenterology, Department of Diseases of the Digestive System, Metabolism and Infectious Diseases, Bologna, Italy
  • 5Policlinico S. Orsola-Malpighi, Università di Bologna, Division of Internal Medicine – Bernardi, Department of Internal Medicine, Cardioangiology and Hepatology, Bologna, Italy

Purpose: Histological recurrence after ortotopic liver transplantation (OLT) for HCV-related cirrhosis is present in the large majority of patients within one year. Fibrosis progresses to cirrhosis within 5 years in 30% of transplant recipients, leading to a 5-years patient survival of about 70%. The aim of the present study was to evaluate the prognostic value of transient elastography (TE, Fibroscan, Echosense) in patients submitted to OLT for HCV-related cirrhosis.

Material and methods: Thirty-four patients with HCV-recurrence after OLT who underwent liver biopsy for clinical purposes between February and August 2005 and between February and June 2007 were enrolled in the study and were followed regularly. TE measurements were performed within 40 days from liver biopsy.

Results: Biopsies and TE measurements were taken after a median time of 26 months (1 – 105 months) from OLT. During a median follow period of 98 months (6 – 195 months), 22 patients were still alive and 12 were dead (3 for HCC, 8 for decompensated cirrhosis and 1 for non liver-related cause). TE median values were 7.9 kPa (4.2 – 13.9) for F1 and 18 kPa (10.2 – 31.6) for F> 1 according to METAVIR classification. No patient had F0. When patients were stratified according to the best cut-off value to predict mortality for all causes (10.1 kPa; AUROC 0.752; 95% CI 0.583 – 0.921), patients with TE values< 10.1 kPa had a higher survival rate than patients with TE values >= 10.1 kPa (84.2% versus 40%; p = 0.007)

Conclusion: TE measurements provides prognostic information on mortality in patients suffering from recurrent HCV infection after transplantation.

Fig. 1: Survival