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Comparison of Acoustic Radiation Force Impulse/Serum Noninvasive Markers for Fibrosis Prediction in Liver Transplant

Pinto, Joana*; Matos, Hugo*; Nobre, Susana; Cipriano, Maria A.; Marques, Margarida§; Pereira, João M.S.§; Gonçalves, Isabel; Noruegas, Maria J.*

Journal of Pediatric Gastroenterology and Nutrition: March 2014 - Volume 58 - Issue 3 - p 382–386
doi: 10.1097/MPG.0000000000000226
Original Articles: Hepatology and Nutrition

Objectives: Fibrosis, related to several causes, can be diagnosed in children and adolescents’ liver grafts that are >1 year old. At present, liver biopsy is the gold standard for assessing liver damage in the posttransplant setting. We aimed to evaluate the accuracy of noninvasive biomarkers of fibrosis, namely, acoustic radiation force impulse (ARFI), aspartate-to-platelet ratio index, and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio index, either alone or in combination, for predicting fibrosis in pediatric patients submitted to liver transplantation.

Methods: We prospectively assessed liver fibrosis in 30 children/adolescents with liver transplant through biopsy (liver transplant follow-up during 12 months). ARFI with Virtual Touch Software (Acuson 2000) was performed, and blood samples were taken to determine liver function and platelet count. Two groups were analyzed according to the histopathologic stage of fibrosis, namely, none/mild (F0–F1) versus significant fibrosis (F2-4).

Results: The mean age of the 30 patients was 11 years (3–18 years), with a mean posttransplant period of assessment of 6.5 years. Twenty-four patients (80%) presented stage F0–F1 fibrosis and 6 patients (20%) presented stage F2-4. The area under the curve using receiver operating characteristic analysis for ARFI, aspartate-to-platelet ratio index, and AST/ALT ratio index for significant fibrosis was 0.76 (P = 0.052), 0.74 (P = 0.066), and 0.69 (P = 0.162), respectively. Through multivariate logistic regression analysis, the only independent predictor of significant fibrosis was ARFI (odds ratio 10.7, 95% confidence interval 1.2–95.7; P = 0.045). The combination of ARFI and AST/ALT ratio index presented a good diagnostic accuracy of fibrosis (area under the curve of 0.83; P = 0.013).

Conclusions: ARFI may serve as a potential method for assessing significant fibrosis in pediatric patients with liver transplant, particularly in combination with AST/ALT ratio index.

*Medical Imaging Department

Hepatology Department, Pediatric Hospital of Coimbra

Pathology Department

§Laboratory of Biostatistics and Medical Informatics, University Hospitals of Coimbra, Coimbra, Portugal.

Address correspondence and reprint requests to Joana Pinto, MD, Medical Imaging Department, Pediatric Hospital of Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal (e-mail:

Received 19 October, 2013

Accepted 19 October, 2013

The authors report no conflicts of interests.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,