Spanish society of liver transplantation (SETH) consensus recommendations on hepatitis C virus and liver transplantation

2012 Liver International 32, 5 (712-731)

Post-transplant follow-up and monitoring of HCV hepatitis. [...] Two types of diagnostic methods are used in the follow-up of recurrent hepatitis C after transplantation: invasive (liver biopsy and measurement of portal pressure gradient) and non-invasive (elastography, biochemical serum and fibrogenesis markers and predictive mathematical models of fibrosis). [...]
Non-invasive methods. Transient elastography. The estimation of liver tissue stiffness (measured in kilopascals, kPa) correlates well with the fibrosis stage and HVPG. Its value in estimating the fibrosis stage has been confirmed in studies of transplants from both cadavers and living donors. The best cut-off values for detection of patients with fibrosis ? 2 have varied in different studies between 7.9 and 10.1 kPa, all of them with high positive predictive values (65-86%) and negative predictive values (88-94%). For cirrhosis diagnosis, the cut-off values used in cadaver donor transplants have ranged from 12 to 12.5 kPa with 50-74% positive predictive values and 99-100% negative predictive while in living donors, these values have been 26.5 kPa with 83% PPV and 100% negative predictive. The cut-off value to estimate the existence of portal hypertension (HVPG >6 mmHg) was 8.7 kPa with a PPV of 81% and NPV of 90%. Performing repeated elastographies has shown its ability to identify patients with significant fibrosis (F ? 2) or patients with HVPG > 6 mmHg as soon as 6 months after transplantation, reaching an excellent diagnostic ability at 12 months. A mathematical model, adding the serum bilirubin level and donor age to the value of liver elastography, significantly improved the diagnostic capability of elastography alone at 6 months to identify the aforementioned patients.
Conclusions: [...]Transient elastography has proven to be the noninvasive method with a greater ability to identify significant fibrosis and portal hypertension in this context and may be an appropriate alternative to biopsies for monitoring the evolution of hepatitis C after transplantation (Class I, level A).

Pubmed : 22221843