Association of shear-wave elastography with clinical outcomes post-liver transplantation - 08/11/20

Doi : 10.1016/j.clinre.2020.09.015

Tom Boeken ^a,^b,⁎ , Olivier Lucidarme ^b,^c, Elsa Mbarki ^a,^b, Olivier Scatton ^d,^e, Eric Savier ^d,^e, Mathilde Wagner ^b,^c
^a Université Paris Descartes - Sorbonne - Paris Cité, France
^b Radiologie Polyvalente et Oncologique, Hôpital Pitié–Salpêtrière, 47, bd de l’Hôpital, 75651 Paris Cedex 13, France
^c Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale (LIB), Service de Radiologie, APHP, Hôpital Pitié–Salpêtrière, Paris, France
^d Chirurgie Digestive et Hépato-BIlio-Pancréatique, Hôpital Pitié–Salpêtrière, 47 blvd de l’Hôpital, 75013, Paris, France
^e Service de chirurgie digestive hépato-bilio-pancréatique transplantation hépatique, Sorbonne Université, Inserm, Institute of Cardiometabolism and Nutrition, ICAN, Centre de Recherche Saint-Antoine, CRSA, AP-HP, CHU Pitie-Salpetriere, Paris, France

^⁎Corresponding author.

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Highlights

•	Patients without complications post-transplantation had stiffer livers (mean 2D-SWE of 7.3kPa) than the general population.
•	Mean±SD liver stiffness values on 2D SWE were significantly higher during the first 90 days post-transplantation than after the first year, respectively: 8.2±2.5 vs. 7.0±2.4kPa.
•	Liver stiffness was more pronounced in patients with biliary complications during the first-year post-transplantation.

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Abstract

Purpose

Two-dimensional shear-wave elastography (2D-SWE) assessment of liver stiffness has the advantage of being obtained during conventional ultrasound. Liver-stiffness values on 2D-SWE for grafted livers are unknown, as are their potential link to post-transplantation morbidity. This study was undertaken to determine liver-stiffness values on 2D-SWE for grafted livers without complications, and examine relationships between liver-stiffness values on 2D-SWE and early post-operative arterial or biliary complications.

Methods

In our facility, all liver-transplant recipients are entered in a comprehensive surgical database, where donor, procedure and recipient characteristics are described. All patients underwent systematic 2D-SWE assessment. Potential relationships were analyzed between liver-stiffness findings and donor, procedure and recipient characteristics, and follow-up events, including death, arterial or biliary complications, graft removal and allograft-dysfunction scores.

Results

Liver-stiffness values on 2D-SWE of 337 ultrasound examinations from 165 liver-transplant recipients were collected retrospectively. Median time from transplantation to 2D-SWE examination was 149 days, with median follow-up at 36 months. The mean±SD stiffness value for grafts without complications was 7.3±2.3kPa; it was significantly higher during the first 90 days (8.2±2.5kPa) post-transplant than after 1year (7.0±2.4kPa) (P=0.01). Patients with biliary complications during the first-year post-transplantation had significantly higher mean liver-stiffness values on 2D-SWE than those without, respectively: 9.8±7.0 vs 7.5±1.8kPa (P=0.01).

Conclusions

Post-transplantation patients without complications had stiffer livers than the general population, with higher values during the first 90 days after surgery. Liver-stiffness values on 2D-SWE were significantly higher for patients with biliary, but not arterial, complications.

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Abbreviations : 2D-SWE, ET-DRI, IQR, MELD, SOFA

Keywords : Bile ducts, Elasticity imaging techniques, End-stage liver disease, Liver transplantation, Ultrasonography