Non-invasive diagnosis of liver fibrosis in the transplant setting

Abstract

Recurrent hepatitis C after liver transplantation is a rapidly evolving condition in which fibrosis deposition is accelerated, with 30% of patients developing graft cirrhosis within the first 5 years after transplantation. Antiviral therapy after transplantation achieves sustained virological response (SVR) in approximately 30% of patients, and a milder fibrosis stage at treatment seems to increase the probabilities of response to treatment. Importantly, SVR to antiviral therapy in this setting has been shown to modify the natural history of the disease, given the excellent prognosis of patients who are able to clear the virus. In this regard, an early recognition of these patients can help to start antiviral therapy in less advanced stages of the recurrence, with higher probabilities of achieving SVR. Non-invasive methods, and especially Fibroscan™, have been shown to significantly correlate with fibrosis stage and, more importantly, to permit early identification of those patients at higher risk of presenting worse outcomes. In addition, they can also confidently distinguish those patients who will present a good outcome and in which a significant number of protocol liver biopsies may be avoided.