Assessing liver stiffness with conventional cut‐off values overestimates liver fibrosis staging in patients who received the Fontan procedure

Aim Patients who undergo the Fontan procedure for complex congenital heart disease are prone to liver cirrhosis. Liver stiffness (LS) reflects liver fibrosis stage in patients with chronic viral hepatitis; however, its accuracy in predicting liver fibrosis stage in Fontan patients is controversial....

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Veröffentlicht in:Hepatology research 2021-05, Vol.51 (5), p.593-602
Hauptverfasser: Cho, Yuki, Kabata, Daijiro, Ehara, Eiji, Yamamoto, Akira, Mizuochi, Tatsuki, Mushiake, Sotaro, Kusano, Hironori, Kuwae, Yuko, Suzuki, Tsugutoshi, Uchida‐Kobayashi, Sawako, Morikawa, Hiroyasu, Amano‐Teranishi, Yuga, Kioka, Kiyohide, Jogo, Atsushi, Isoura, Yoshiharu, Hamazaki, Takashi, Murakami, Yosuke, Tokuhara, Daisuke
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container_end_page 602
container_issue 5
container_start_page 593
container_title Hepatology research
container_volume 51
creator Cho, Yuki
Kabata, Daijiro
Ehara, Eiji
Yamamoto, Akira
Mizuochi, Tatsuki
Mushiake, Sotaro
Kusano, Hironori
Kuwae, Yuko
Suzuki, Tsugutoshi
Uchida‐Kobayashi, Sawako
Morikawa, Hiroyasu
Amano‐Teranishi, Yuga
Kioka, Kiyohide
Jogo, Atsushi
Isoura, Yoshiharu
Hamazaki, Takashi
Murakami, Yosuke
Tokuhara, Daisuke
description Aim Patients who undergo the Fontan procedure for complex congenital heart disease are prone to liver cirrhosis. Liver stiffness (LS) reflects liver fibrosis stage in patients with chronic viral hepatitis; however, its accuracy in predicting liver fibrosis stage in Fontan patients is controversial. We aimed to clarify the correlation between LS and liver fibrosis stage in Fontan patients. Methods Fifty‐eight Fontan patients were prospectively measured for LS with transient elastography. We undertook liver biopsy, cardiac catheterization, and laboratory tests in 22 of these patients (median age, 14.7 years; range, 9.9–32.1 years) with LS > 11.0 kPa (median, 19.2 kPa; range, 12.2–39.8 kPa); these elevated LS values suggest liver cirrhosis. Results Histologically, all patients showed mild‐to‐severe portal and sinusoidal fibrosis but no cirrhosis. Statistically, LS did not predict histological liver fibrosis scores (p = 0.175). Liver stiffness was not correlated with central venous pressure (p = 0.456) or with the hepatic venous pressure gradient (HVPG; p = 0.062), although the p value for HVPG was only slightly above the threshold for significance. Conclusions Fontan patients are prone to developing both portal and sinusoidal fibrosis. Liver stiffness could be influenced by HVPG, and using the conventional cut‐off values for LS overestimates and overtreats liver fibrosis in these patients.
doi_str_mv 10.1111/hepr.13627
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Liver stiffness (LS) reflects liver fibrosis stage in patients with chronic viral hepatitis; however, its accuracy in predicting liver fibrosis stage in Fontan patients is controversial. We aimed to clarify the correlation between LS and liver fibrosis stage in Fontan patients. Methods Fifty‐eight Fontan patients were prospectively measured for LS with transient elastography. We undertook liver biopsy, cardiac catheterization, and laboratory tests in 22 of these patients (median age, 14.7 years; range, 9.9–32.1 years) with LS &gt; 11.0 kPa (median, 19.2 kPa; range, 12.2–39.8 kPa); these elevated LS values suggest liver cirrhosis. Results Histologically, all patients showed mild‐to‐severe portal and sinusoidal fibrosis but no cirrhosis. Statistically, LS did not predict histological liver fibrosis scores (p = 0.175). Liver stiffness was not correlated with central venous pressure (p = 0.456) or with the hepatic venous pressure gradient (HVPG; p = 0.062), although the p value for HVPG was only slightly above the threshold for significance. Conclusions Fontan patients are prone to developing both portal and sinusoidal fibrosis. Liver stiffness could be influenced by HVPG, and using the conventional cut‐off values for LS overestimates and overtreats liver fibrosis in these patients.</description><identifier>ISSN: 1386-6346</identifier><identifier>EISSN: 1872-034X</identifier><identifier>DOI: 10.1111/hepr.13627</identifier><identifier>PMID: 33677839</identifier><language>eng</language><publisher>Netherlands: Wiley Subscription Services, Inc</publisher><subject>Bile ; Biopsy ; Catheterization ; Cirrhosis ; Coronary artery disease ; Fibrosis ; Fontan procedure ; Heart diseases ; Heart surgery ; hepatic venous pressure gradient ; Hepatitis ; Liver cirrhosis ; Liver diseases ; liver fibrosis ; liver stiffness ; transient elastography</subject><ispartof>Hepatology research, 2021-05, Vol.51 (5), p.593-602</ispartof><rights>2021 The Authors. Hepatology Research published by John Wiley &amp; Sons Australia, Ltd on behalf of Japan Society of Hepatology.</rights><rights>2021. 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Liver stiffness (LS) reflects liver fibrosis stage in patients with chronic viral hepatitis; however, its accuracy in predicting liver fibrosis stage in Fontan patients is controversial. We aimed to clarify the correlation between LS and liver fibrosis stage in Fontan patients. Methods Fifty‐eight Fontan patients were prospectively measured for LS with transient elastography. We undertook liver biopsy, cardiac catheterization, and laboratory tests in 22 of these patients (median age, 14.7 years; range, 9.9–32.1 years) with LS &gt; 11.0 kPa (median, 19.2 kPa; range, 12.2–39.8 kPa); these elevated LS values suggest liver cirrhosis. Results Histologically, all patients showed mild‐to‐severe portal and sinusoidal fibrosis but no cirrhosis. Statistically, LS did not predict histological liver fibrosis scores (p = 0.175). Liver stiffness was not correlated with central venous pressure (p = 0.456) or with the hepatic venous pressure gradient (HVPG; p = 0.062), although the p value for HVPG was only slightly above the threshold for significance. Conclusions Fontan patients are prone to developing both portal and sinusoidal fibrosis. 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Liver stiffness (LS) reflects liver fibrosis stage in patients with chronic viral hepatitis; however, its accuracy in predicting liver fibrosis stage in Fontan patients is controversial. We aimed to clarify the correlation between LS and liver fibrosis stage in Fontan patients. Methods Fifty‐eight Fontan patients were prospectively measured for LS with transient elastography. We undertook liver biopsy, cardiac catheterization, and laboratory tests in 22 of these patients (median age, 14.7 years; range, 9.9–32.1 years) with LS &gt; 11.0 kPa (median, 19.2 kPa; range, 12.2–39.8 kPa); these elevated LS values suggest liver cirrhosis. Results Histologically, all patients showed mild‐to‐severe portal and sinusoidal fibrosis but no cirrhosis. Statistically, LS did not predict histological liver fibrosis scores (p = 0.175). Liver stiffness was not correlated with central venous pressure (p = 0.456) or with the hepatic venous pressure gradient (HVPG; p = 0.062), although the p value for HVPG was only slightly above the threshold for significance. Conclusions Fontan patients are prone to developing both portal and sinusoidal fibrosis. Liver stiffness could be influenced by HVPG, and using the conventional cut‐off values for LS overestimates and overtreats liver fibrosis in these patients.</abstract><cop>Netherlands</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33677839</pmid><doi>10.1111/hepr.13627</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-2441-5062</orcidid><orcidid>https://orcid.org/0000-0001-9119-4864</orcidid><orcidid>https://orcid.org/0000-0003-3885-432X</orcidid><orcidid>https://orcid.org/0000-0003-1974-4790</orcidid><oa>free_for_read</oa></addata></record>
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subjects Bile
Biopsy
Catheterization
Cirrhosis
Coronary artery disease
Fibrosis
Fontan procedure
Heart diseases
Heart surgery
hepatic venous pressure gradient
Hepatitis
Liver cirrhosis
Liver diseases
liver fibrosis
liver stiffness
transient elastography
title Assessing liver stiffness with conventional cut‐off values overestimates liver fibrosis staging in patients who received the Fontan procedure
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