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Development of Clinical Algorithm Utilizing Vibration-Controlled Transient Elastography to Detect Advanced Hepatic Fibrosis in Liver Transplant Recipients.
Arshad, Tamoore; Vainer, Dylan; Khan, Hiba; Baral, Alok; Garg, Shreya; Ang, Audrey; Patel, Vaishali; Kumaran, Vinay; Bruno, David; Lee, Seung; Sharma, Amit; Muthiah, Mark; Bui, Anh T; Siddiqui, Mohammad Shadab.
Afiliación
  • Arshad T; Department of Internal Medicine, Virginia Commonwealth University (VCU), Richmond, USA.
  • Vainer D; Department of Internal Medicine, Virginia Commonwealth University (VCU), Richmond, USA.
  • Khan H; Department of Internal Medicine, Virginia Commonwealth University (VCU), Richmond, USA.
  • Baral A; Department of Internal Medicine, Virginia Commonwealth University (VCU), Richmond, USA.
  • Garg S; Department of Internal Medicine, Virginia Commonwealth University (VCU), Richmond, USA.
  • Ang A; Department of Internal Medicine, Virginia Commonwealth University (VCU), Richmond, USA.
  • Patel V; Division of Gastroenterology and Hepatology, VCU, MCV Campus, West Hospital, 1200 E. Broad St, PO Box 980341, Richmond, VA, 23298-0341, USA.
  • Kumaran V; Division of Transplant Surgery, VCU, Richmond, USA.
  • Bruno D; Division of Transplant Surgery, VCU, Richmond, USA.
  • Lee S; Division of Transplant Surgery, VCU, Richmond, USA.
  • Sharma A; Division of Transplant Surgery, VCU, Richmond, USA.
  • Muthiah M; National University, Singapore, Singapore.
  • Bui AT; Department of Statistical Sciences & Operations Research, Virginia Commonwealth University (VCU), Richmond, USA.
  • Siddiqui MS; Division of Gastroenterology and Hepatology, VCU, MCV Campus, West Hospital, 1200 E. Broad St, PO Box 980341, Richmond, VA, 23298-0341, USA. mohammad.siddiqui@vcuhealth.org.
Dig Dis Sci ; 69(5): 1844-1851, 2024 May.
Article en En | MEDLINE | ID: mdl-38499735
ABSTRACT

INTRODUCTION:

Vibration-controlled transient elastography (VCTE) based liver stiffness measurement (LSM) is an excellent 'rule-out' test for advanced hepatic fibrosis in liver transplant (LT) recipients, however, its ability to 'rule-in' the disease is suboptimal. The study aimed to improve diagnostic performance of LSM in LT recipients.

METHODS:

Adult LT recipients with a liver biopsy and VCTE were included (N = 150). Sequential covering analysis was performed to create rules to identify patients at low or high risk for advanced fibrosis (stage 3-4).

RESULTS:

Advanced hepatic fibrosis was excluded in patients with either LSM < 7.45 kPa (n = 72) or 7.45 ≤ LSM < 12.1 kPa and time from LT < 5.6 years (n = 25). Conversely, likelihood of advanced fibrosis was 95% if patients had LSM > 14.1 and controlled attenuation parameter > 279 dB/m (n = 21). Thus, 118 (79%) were correctly identified and 32 (21%) would have required a biopsy to establish the diagnosis. Compared to previously established LSM based cutoff values of 10.5 kPa (Youden index) and 13.3 kPa (maximized specificity), the false positive rates of sequential covering analysis was 1% compared to 16.5% with LSM ≥ 10.5 kPa and 8.3% with LSM ≥ 13.3 kPa. The true positive rates were comparable at 87% for sequential covering analysis, 93% for LSM ≥ 10.5 kPa and 83% for LSM ≥ 13.3 kPa.

CONCLUSION:

The proposed clinical sequential covering analysis allows for better risk stratification when evaluating for advanced fibrosis in LT recipients compared to LSM alone. Additional efforts are necessary to further reduce the number of patients with indeterminate results in whom a liver biopsy may be required.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vibración / Algoritmos / Trasplante de Hígado / Diagnóstico por Imagen de Elasticidad / Cirrosis Hepática Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Dig Dis Sci Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vibración / Algoritmos / Trasplante de Hígado / Diagnóstico por Imagen de Elasticidad / Cirrosis Hepática Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Dig Dis Sci Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos