Non-invasive assessment of liver fibrosis using magnetic resonance elastography in liver transplant recipients with hepatitis C

Background: Liver biopsy has been the reference standard when evaluating fibrosis due to recurrent hepatitis after liver transplantation. Magnetic resonance elastography estimates liver stiffness, correlating to fibrosis. Aim: To investigate the utility of elastography in staging liver fibrosis in transplant recipients with hepatitis C. Methods: Fifty-four patients, ≥12 months post-transplant, underwent elastography within three months of biopsy. Discriminatory capability for METAVIR fibrosis stages F0-2 vs. F3-4 and receiver operating characteristic curve (ROC) analysis were determined. Results: On biopsy, 27 patients had METAVIR fibrosis score 0-1; 12 had a 3 or 4. There was significant correlation between histologic fibrosis and shear stiffness (R² = 0.588, p < 0.0001). Using a cutoff value of 3.5 kPa, elastography was 91% sensitive and 72% specific in differentiating fibrosis scores of ≥3 from 0 to 1. The AUC of elastography in predicting a fibrosis score of ≥3 was 0.92. Multivariate analysis revealed no correlation between the grade of histologic inflammation and liver stiffness measured by magnetic resonance elastography (R² = 0.265, p = 0.47). Conclusion: Magnetic resonance elastography is an accurate non-invasive technique for excluding stage ≥3 graft in recipients with hepatitis C.