| Abstract: | BACKGROUND: The role of non-invasive liver disease assessment by two-dimensional shear wave elastography (2D-SWE) to diagnose fibrosis is well described in patients with chronic liver disease. However, its role in prognosis, especially after liver transplantation (LT) has not been adequately examined. We hypothesized that elevated liver stiffness measurement (LSM) as measured by 2D-SWE post LT predicts future morbidity and mortality independent of fibrosis by liver biopsy. METHODS: In a prospective cohort study, consecutive LT recipients underwent concomitant protocol 2D-SWE and protocol liver biopsy (2012-2014), with assessor blinded to biopsy findings. We examined the baseline correlation of LSM with fibrosis stage and the association between elevated LSM and development of subsequent clinical outcomes and all-cause mortality. RESULTS: 187 LT recipients (median age 58 years, 38.5% women, median BMI 26.5, 55.1% HCV, 17.6% Non-alcoholic steatohepatitis/cryptogenic) were examined. Median time between LT and biopsy/2D-SWE assessment was 4.0 years and median follow-up after LSM determination was 3.5 years. Median LSM was 9 kPa [8 kPa (F0/F1), 11.5 kPa (F2), 12 kPa (F3/F4)]. There was a positive correlation between LSM and fibrosis stage (rs = 0.41, p<0.001). LSM ≥11 kPa was associated with lower survival within 3 years (84.8 vs. 93.7%; p=0.04). After adjusting for age, gender and fibrosis stage, LSM ≥11 kPa was independently associated with mortality (HR: 2.45, 95% CI: 1.08-5.60). CONCLUSION: Elevated LSM by 2D-SWE is associated with increased mortality after LT independent of hepatic fibrosis. 2D-SWE may serve as a novel non-invasive prognostic tool to predict relevant outcomes late after LT especially given the overall decrease in use of liver biopsy in the current era. |
