Assessment of Liver Stiffness in Pediatric Fontan Patients Using Transient Elastography
Becky Chen1, Richard A Schreiber1, Derek G Human2
1Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Division of Gastroenterology, Hepatology and Nutrition, British Columbia Children's Hospital, Vancouver, BC, Canada.
Insights
Pediatric Fontan patients show significantly higher liver stiffness, indicating potential fibrosis. Transient elastography (TE) is a feasible, noninvasive tool for monitoring liver health in these children.
Area of Science:
- Pediatric Cardiology
- Hepatology
- Noninvasive Diagnostics
Background:
- Hepatic fibrosis is a known complication post-Fontan surgery, increasing cirrhosis risk.
- Transient elastography (TE) offers a rapid, noninvasive method for assessing liver stiffness and fibrosis.
- Monitoring liver health is crucial for long-term outcomes in Fontan patients.
Purpose of the Study:
- To compare liver stiffness in pediatric Fontan patients versus age- and sex-matched controls.
- To evaluate liver biochemistries in the same cohorts.
- To determine patient acceptance and feasibility of TE in this population.
Main Methods:
- Twenty-two pediatric Fontan patients were recruited from British Columbia Children's Hospital.
- Demographic, cardiac data, and transient elastography (TE) measurements were collected.
- TE values were compared to age- and sex-matched healthy controls.
Main Results:
- Fontan patients exhibited significantly higher liver stiffness (median 18.6 kPa) compared to controls (median 4.7 kPa) (p < 0.001).
- No significant association was found between TE values and patient age, time since surgery, or Fontan circuit pressure.
- Patients reported TE as nonpainful, convenient, and safe.
Conclusions:
- Transient elastography is a feasible method for assessing liver stiffness in pediatric Fontan patients.
- Pediatric Fontan survivors demonstrate markedly elevated liver stiffness.
- TE holds significant potential for routine liver care follow-up in this high-risk group.
Abstract:
Background. Hepatic fibrosis is a potential complication following Fontan surgery and heralds long-term risk for cirrhosis. Transient elastography (TE) is a rapid, noninvasive method to assess liver fibrosis by measuring liver stiffness. Objectives. To compare liver stiffness and liver biochemistries in pediatric Fontan patients with age- and sex-matched controls and to determine patients' acceptance of TE. Methods. Patients were recruited from British Columbia Children's Hospital. Twenty-two Fontan patients (15 males) were identified. Demographic information and cardiac data were collected. TE was measured using size-appropriate probes. Results. The median age of the Fontan cohort was 13.7 (5.9-16.8) years. Time from Fontan surgery to TE was 9.6 (1.0-12.9) years. The median Fontan circuit pressure was 13 (11-14) mmHg. TE values were higher in Fontan patients versus controls (18.6 versus 4.7 kPa, p < 0.001). There was no association between TE values and patient age (r = 0.41, p = 0.058), time since Fontan surgery (r = 0.40, p = 0.062), or median Fontan circuit pressure (CVP) (r = 0.35, p = 0.111). Patients found TE to be nonpainful, convenient, and safe. Conclusions. TE is feasible to assess liver stiffness in children following Fontan surgery. Pediatric Fontan patients have markedly elevated liver stiffness values. TE may have important utility in liver care follow-up of pediatric Fontan patients.
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