Abstract :
Background:
Liver stiffness as measured by transient elastography (Fibroscan® ) is correlated with the degree of liver fibrosis in HBV-infected patients with normal renal function. The usefulness of Fibroscan® in assessing liver fibrosis in HBV-infected patients with end-stage renal disease (ERSD) is unknown. The study were aimed to compare the performance of Fibroscan® for the assessment of significant liver fibrosis in HBV-infected patients with ESRD to those having normal renal function and to investigate the effect of serum alanine aminotransferase (ALT) levels on liver stiffness measurement
Methods: We prospectively enrolled renal transplant candidates with chronic HBV infection who underwent liver biopsy and liver stiffness measurement to evaluate the severity of liver disease. The cohort was compared to patients with chronic hepatitis B who underwent liver biopsy prior to antiviral treatment in the same calendar year. Liver histology was evaluated and graded by METAVIR scoring system and liver stiffness was expressed as kPa.
Results:
Patients with ESRD had a mean (SEM) age of 40.5 ±3.1 years and 83% were male. Eleven patients were on hemodialysis and 4 were received oral antiviral agents with a median duration of 22 months (ranged from 17 to 31 months) prior to histologic evaluation. The HBeAg was negative in 10 (83%) patients, andtwo were HBeAg-positive. Alanine aminotransferase activities ranged from 9 to 77 U/L (median level of 22 U/L).None of the patients had criteria for liver cirrhosis and ascites in the ultrasound examination. According to the METAVIR classification, 7 patients had stage 0-I, 4 had stage II, and 1 had stage III disease. Compared to patients with normal renal function, ESRD group had significantly lower body mass index (21.4 ±0.7 vs. 23.9 ± 0.3 kg/m p = 0.01), HBV DNA (×106 IU/ml) 5.1 ± 3.6 vs. 13.8 ± 2.3, p = 0.0007, AST (22 ± 3.5 vs. 44 ±3.8 units/L, p =0.0002), ALT (25 ± 5.3 vs. 62 ± 6.8 units/L, p = 0.0009) and hemoglobin level (11.4 ± 0.7 vs. 14 ± 0.1 g/dL, p =0.0004). Liver stiffness values were similar between both groups. To predict significant fibrosis (grade II), optimal cutoff value of Fibroscan® at 5.9 kPa with the area under the curve (AUC) of 0.86 in ESRD patients yielded a sensitivity of 100%, specificity of 71%, positive predictive value (PPV) of 71%, and negative predictive value (NPV) of 100%. Whereas in patients with normal renal function, optimal liver stiffness value of 6.8 kPa with the AUC of 0.76 provided a sensitivity of 74%, specificity of 75%, PPV of 75%, and NPV of 74%.
Conclusions:
Fibroscan® is a reliable mean for evaluating the severity of liver disease in HBV-infected patients with ERSD, with higher performance compared to patients with normal renal function at the same stage of liver fibrosis. As elevated serum ALT levels have the influence on the diagnostic performance of liver stiffness measurement, a lower liver stiffness measurement may be needed to diagnose different degrees of liver fibrosis in HBV-infected patients with ESRD.
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file/Thai-Journal-of-gastroenterology-vol-10-no-2-1899300.pdf