Z Gastroenterol 2014; 52 - KG147
DOI: 10.1055/s-0034-1386169

Transient Elastography in the follow-up after liver transplantation

A Hamann 1, IW Graziadei 2, G Millonig 1, 3
  • 1Medizinische Universität Innsbruck, Innere Medizin II/Gastroenterologie und Hepatologie, Innsbruck, Austria
  • 2Landeskrankenhaus Hall in Tirol, Innere Medizin, Hall in Tirol, Austria
  • 3Klinikum Friedrichshafen, Innere Medizin I/Gastroenterologie, Friedrichshafen, Germany

Background: Transient Elastography is a non invasive method to determine liver stiffness (LS). Besides liver fibrosis other conditions such as heart failure, flares of hepatitis, and bile duct obstruction can lead to increased LS values.

Aim of the study: To evaluate the usefulness of transient elastography in patients after liver transplantation (LT) and the causes of increased LS after LT.

Patients: A cohort of 235 patients 1 – 11 years after LT has been evaluated by conventional ultrasound, lab tests and transient elastography and-if available-by liver histology. A total of 573 valid elastography measurements were available for evaluation.

Results:

  • The rate of invalid measurements in patients after LT is higher (13.6%) than in healthy controls known from literature, most likely due to obesity

  • LS after LT in patients with good graft function is comparable to healthy non-transplanted individuals (2.5 – 6kPa)

  • Median LS remained stable over the years after transplantation (5.5 – 6.8kPa, range 2.4 – 75 kPa).

  • A total of 142 out of 573 measurements showed LS values above normal (6 – 75kPa). 27% of these were due to bile duct complications, 12.7% were due to recurrent alcoholic liver disease, 8.5% due to HCV recurrence. 5.6% were explained by a combination of recurrence of alcoholic liver disease in combination with either bile duct complications or HCV. 5.6% were due to reperfusion damage. The remaining 7.7% of pathological LS measurements were explained by rare conditions such as rejection episodes, PSC recurrence, HBV-recurrence (incompliance with therapy), de novo plasmacell hepatitis or drug induced liver damage.

  • The reason of increased LS values remained unanswered in 32.4%, most of them were in the range between 6 – 8kPa, where the significance of the result is unclear.

Conclusion: LS measurement by transient elastography is a valuable tool for follow-up of patients after LT. Although an increase in LS is non-specific, it is a sensitive parameter for ongoing pathology in the liver.

Elevated LS values > 8.5kPa even with only moderate transaminases should therefore prompt liver biopsy. This is illustrated by one of our patients where a de novo plasma cell hepatitis primarily manifested with elevated LS values that went back to normal after treatment.