Multiparametric ultrasound-based assessment of liver grafts for the detection of graft fibrosis and steatosis

Introduction Patients after liver transplantation require close monitoring for graft steatosis and fibrosis due to the risk for metabolic complications from immunosuppressants or liver disease recurrence. Transient elastography (TE) was shown to be able to detect graft fibrosis, whereas controlled attenuation parameter (CAP) could identify graft steatosis. This study aimed to evaluate the effectiveness of three methods for non-invasive multiparametric assessment of graft fibrosis and steatosis in liver transplant recipients.

Methods 38 patients were included in this pilot study. Graft fibrosis and steatosis were assessed through ultrasound-based techniques embedded on the Hologic MACH 30 machine: ShearWave PLUS Elastography (SWPE), Attenuation PLUS (AttPLUS) and Sound Speed PLUS (SSP). Non-invasive serum-based tests for fibrosis were calculated. Transient Elastography (TE) and Controlled Attenuation Parameter (CAP) performed on a FibroScan 630 Expert were considered as reference.

Results 44.7% of our cohort were female with a median time since transplantation of 3.58 years. 7 patients showed fibrosis on TE. SWPE showed the best predictive value for liver fibrosis with an AUROC of 0.922. NITs performed poor with AUROCs for FIB-4, APRI and NFS of 0.615, 0.622 and 0.577, respectively. SWPE and liver stiffness measurement by TE correlated significantly (r=0.589, p<0.001). For steatosis assessment, SSP measurements showed a significant inverse correlation with CAP (r=-0.605, p<0.001), whereas AttPLUS did not correlate with CAP values.

Conclusion Multiparametric ultrasound assessment showed promising results in assessing graft fibrosis and steatosis. However, larger studies are required to validate these findings and to identify clinically significant cut-offs.

Publication History

Article published online:
23 January 2024