Two-Dimensional Shear Wave Elastography Evaluation of Post-transplantation Complications in Pediatric Receipt: A
Li-Hong Gu1,2, Zi-Cheng Lv1, Hao-Xiang Wu1
1Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Insights
Two-dimensional shear wave elastography (2D-SWE) effectively assesses liver stiffness in pediatric liver transplant recipients. This imaging technique accurately predicts liver graft fibrosis, improving long-term outcomes.
Area of Science:
- Hepatology
- Transplantation Medicine
- Medical Imaging
Background:
- Pediatric liver transplantation (LT) survival rates are suboptimal, with hepatic fibrosis impacting long-term prognosis.
- Current imaging methods for pediatric liver graft assessment lack sufficient sensitivity and specificity.
- Two-dimensional shear wave elastography (2D-SWE) offers a promising approach to evaluate liver graft stiffness and complications.
Purpose of the Study:
- To evaluate the efficacy of 2D-SWE in assessing liver graft stiffness in pediatric recipients.
- To determine the correlation between 2D-SWE measurements and post-transplant complications such as fibrosis, rejection, and biliary issues.
- To establish the diagnostic performance of 2D-SWE for identifying significant liver graft fibrosis.
Main Methods:
- A retrospective cohort study included 343 pediatric liver transplant recipients undergoing biopsy.
- 2D-SWE, laboratory tests, and liver biopsy with pathological assessment were performed.
- Ninety-eight patients met the study protocol for analysis.
Main Results:
- Liver Stiffness Measurement (LSM) values via 2D-SWE were significantly elevated in patients with post-transplant fibrosis (p < 0.0001).
- Elevated LSM values correlated with biliary complications (p < 0.0001) and biopsy-proven rejection (p = 0.0016).
- 2D-SWE demonstrated high diagnostic accuracy for liver graft fibrosis, with an AUC of 88% and an optimal cutoff of 10.3 kPa.
Conclusions:
- 2D-SWE is an efficient method for measuring liver stiffness in pediatric liver transplant recipients.
- Routine 2D-SWE evaluation can effectively predict significant liver graft fibrosis, aiding in patient management.
Background:
The 20-year survival rate in pediatric patients after liver transplantation (LT) was no more than 70%. Hepatic fibrosis is one of the principal factors affecting the long-term prognosis. Imaging evaluation was the first-line examination for pediatric liver graft assessment. However, the sensitivity and specificity were insufficient. Thus, two-dimensional shear wave elastography (2D-SWE) was performed to evaluate liver graft stiffness and complication in post-transplant pediatric receipt.
Materials And Methods:
In this retrospective cohort, 343 pediatric recipients who underwent liver graft biopsy in our tertiary LT center were recruited between June 2018 and December 2020. The 2D-SWE evaluation, laboratory examination, routine post-transplant biopsy, and hepatic pathological assessment were performed.
Results:
Ninety-eight of the 343 pediatric patients were included according to the protocol. The Liver Stiffness Measurements (LSM) value of 2D-SWE was significantly elevated in post-transplant fibrosis (p < 0.0001). The LSM value of patients with post-transplant biliary complications (p < 0.0001) and biopsy-proven rejection (BPR, p = 0.0016) also rose compared to regular recovery patients. Concerning the sensitivity and specificity of 2D-SWE in diagnosing liver graft fibrosis, the area under the ROC curve (AUC) was 88%, and the optimal cutoff value was 10.3 kPa.
Conclusion:
Pediatric LSM by 2D-SWE was efficient. Routine 2D-SWE evaluation could be optimal to predict significant liver graft fibrosis.
