Share this article on:

Transient Elastography Is a Useful Noninvasive Tool for the Evaluation of Fibrosis in Paediatric Chronic Liver Disease

Fitzpatrick, Emer*; Quaglia, Alberto; Vimalesvaran, Sunitha*; Basso, Maria Sole; Dhawan, Anil*

Journal of Pediatric Gastroenterology & Nutrition: January 2013 - Volume 56 - Issue 1 - p 72–76
doi: 10.1097/MPG.0b013e31826f2760
Original Articles: Hepatology and Nutrition

Background: Outcome of liver disease in children is mainly determined by severity and progression of liver fibrosis. Liver biopsy is the accepted standard for evaluating fibrosis but is limited by the need for sedation in children, sampling error, and risks including bleeding. The aim of the present study was to compare tools for noninvasive assessment of liver fibrosis in a paediatric cohort.

Methods: Children undergoing liver biopsy for chronic liver disease were recruited and underwent transient elastography (TE). Liver biopsies were scored by a hepatohistopathologist from F0 (no fibrosis) to F4 (cirrhosis). TE was compared with biopsy score.

Results: During the study period, 104 children (62 boys) were enrolled (median age 13.6 years). Diagnosis was autoimmune liver disease in 27; nonalcoholic fatty liver disease in 37; posttransplant in 16; hepatitis B/C in 8; Wilson disease in 5; and the remainder, miscellaneous. TE was successful in all but 7 patients and was a good discriminator of significant fibrosis (≥F2) (P < 0.001), severe fibrosis (≥F3) (P < 0.001), and cirrhosis (F4) (P = 0.003). The area under the receiver operating characteristic curve for the prediction of ≥F2, ≥F3, and F4 using TE was 0.78, 0.79, and 0.96, respectively. TE performed best in children with autoimmune liver disease and in those posttransplant.

Conclusions: The present study demonstrates that TE is a reliable tool in distinguishing different stages of liver fibrosis in paediatric patients. Thus, TE may serve as a useful adjunct to liver biopsy for diagnostic purposes providing a reliable method of noninvasively monitoring liver disease progression in children.

*Paediatric Liver, GI and Nutrition Centre

Institute of Liver Studies, King's College London School of Medicine at King's College Hospital, London, UK

Department Paediatric Gastroenterology and Hepatology, Bambino de Jesu, Rome, Italy.

Address correspondence and reprint requests to Professor Anil Dhawan, Paediatric Liver, GI and Nutrition Centre, King's College Hospital, Denmark Hill, London SE5 9PJ, UK (e-mail:

Received 12 May, 2012

Accepted 2 August, 2012

The authors report no conflicts of interest.

Copyright 2013 by ESPGHAN and NASPGHAN