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 |
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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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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.</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 & Sons Australia, Ltd on behalf of Japan Society of Hepatology.</rights><rights>2021. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4257-e426d39912dc9bfdde239e02997561db6d9cbe3837c1d68431d8493a33789da23</citedby><cites>FETCH-LOGICAL-c4257-e426d39912dc9bfdde239e02997561db6d9cbe3837c1d68431d8493a33789da23</cites><orcidid>0000-0002-2441-5062 ; 0000-0001-9119-4864 ; 0000-0003-3885-432X ; 0000-0003-1974-4790</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fhepr.13627$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fhepr.13627$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33677839$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cho, Yuki</creatorcontrib><creatorcontrib>Kabata, Daijiro</creatorcontrib><creatorcontrib>Ehara, Eiji</creatorcontrib><creatorcontrib>Yamamoto, Akira</creatorcontrib><creatorcontrib>Mizuochi, Tatsuki</creatorcontrib><creatorcontrib>Mushiake, Sotaro</creatorcontrib><creatorcontrib>Kusano, Hironori</creatorcontrib><creatorcontrib>Kuwae, Yuko</creatorcontrib><creatorcontrib>Suzuki, Tsugutoshi</creatorcontrib><creatorcontrib>Uchida‐Kobayashi, Sawako</creatorcontrib><creatorcontrib>Morikawa, Hiroyasu</creatorcontrib><creatorcontrib>Amano‐Teranishi, Yuga</creatorcontrib><creatorcontrib>Kioka, Kiyohide</creatorcontrib><creatorcontrib>Jogo, Atsushi</creatorcontrib><creatorcontrib>Isoura, Yoshiharu</creatorcontrib><creatorcontrib>Hamazaki, Takashi</creatorcontrib><creatorcontrib>Murakami, Yosuke</creatorcontrib><creatorcontrib>Tokuhara, Daisuke</creatorcontrib><title>Assessing liver stiffness with conventional cut‐off values overestimates liver fibrosis staging in patients who received the Fontan procedure</title><title>Hepatology research</title><addtitle>Hepatol Res</addtitle><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.</description><subject>Bile</subject><subject>Biopsy</subject><subject>Catheterization</subject><subject>Cirrhosis</subject><subject>Coronary artery disease</subject><subject>Fibrosis</subject><subject>Fontan procedure</subject><subject>Heart diseases</subject><subject>Heart surgery</subject><subject>hepatic venous pressure gradient</subject><subject>Hepatitis</subject><subject>Liver cirrhosis</subject><subject>Liver diseases</subject><subject>liver fibrosis</subject><subject>liver stiffness</subject><subject>transient elastography</subject><issn>1386-6346</issn><issn>1872-034X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp9kc9qFTEUhwdRbK1ufAAJuBFhapIzN5ksS2mtUFBEwd2QSc70psydXJPMLd35BvqMfZKe61QXLswmf_jOF875VdVLwY8FrXdr3KZjAUrqR9WhaLWsOTTfHtMZWlUraNRB9Szna86F5rJ5Wh0AKK1bMIfVz5OcMecwXbEx7DCxXMIwTPTEbkJZMxenHU4lxMmOzM3l7sevOAxsZ8cZM4tUgVSxsYVui2AIfYo5ZDLZq703TGxrSyALOdeRJXRIpGdljew8TsUSkKJDPyd8Xj0Z7JjxxcN-VH09P_tyelFffnz_4fTksnaNXOkaG6k8GCOkd6YfvEcJBrk0Rq-U8L3yxvUILWgnvGobEL5tDFgA3RpvJRxVbxYv_fydWindJmSH42gnjHPuZGNaY2iOQOjrf9DrOCeaB1ErycGsgBui3i6Uo-5zwqHbJppLuu0E7_YxdfuYut8xEfzqQTn3G_R_0T-5ECAW4CaMePsfVXdx9unzIr0HvWChUw</recordid><startdate>202105</startdate><enddate>202105</enddate><creator>Cho, Yuki</creator><creator>Kabata, Daijiro</creator><creator>Ehara, Eiji</creator><creator>Yamamoto, Akira</creator><creator>Mizuochi, Tatsuki</creator><creator>Mushiake, Sotaro</creator><creator>Kusano, Hironori</creator><creator>Kuwae, Yuko</creator><creator>Suzuki, Tsugutoshi</creator><creator>Uchida‐Kobayashi, Sawako</creator><creator>Morikawa, Hiroyasu</creator><creator>Amano‐Teranishi, Yuga</creator><creator>Kioka, Kiyohide</creator><creator>Jogo, Atsushi</creator><creator>Isoura, Yoshiharu</creator><creator>Hamazaki, Takashi</creator><creator>Murakami, Yosuke</creator><creator>Tokuhara, Daisuke</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TM</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope><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></search><sort><creationdate>202105</creationdate><title>Assessing liver stiffness with conventional cut‐off values overestimates liver fibrosis staging in patients who received the Fontan procedure</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4257-e426d39912dc9bfdde239e02997561db6d9cbe3837c1d68431d8493a33789da23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Bile</topic><topic>Biopsy</topic><topic>Catheterization</topic><topic>Cirrhosis</topic><topic>Coronary artery disease</topic><topic>Fibrosis</topic><topic>Fontan procedure</topic><topic>Heart diseases</topic><topic>Heart surgery</topic><topic>hepatic venous pressure gradient</topic><topic>Hepatitis</topic><topic>Liver cirrhosis</topic><topic>Liver diseases</topic><topic>liver fibrosis</topic><topic>liver stiffness</topic><topic>transient elastography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cho, Yuki</creatorcontrib><creatorcontrib>Kabata, Daijiro</creatorcontrib><creatorcontrib>Ehara, Eiji</creatorcontrib><creatorcontrib>Yamamoto, Akira</creatorcontrib><creatorcontrib>Mizuochi, Tatsuki</creatorcontrib><creatorcontrib>Mushiake, Sotaro</creatorcontrib><creatorcontrib>Kusano, Hironori</creatorcontrib><creatorcontrib>Kuwae, Yuko</creatorcontrib><creatorcontrib>Suzuki, Tsugutoshi</creatorcontrib><creatorcontrib>Uchida‐Kobayashi, Sawako</creatorcontrib><creatorcontrib>Morikawa, Hiroyasu</creatorcontrib><creatorcontrib>Amano‐Teranishi, Yuga</creatorcontrib><creatorcontrib>Kioka, Kiyohide</creatorcontrib><creatorcontrib>Jogo, Atsushi</creatorcontrib><creatorcontrib>Isoura, Yoshiharu</creatorcontrib><creatorcontrib>Hamazaki, Takashi</creatorcontrib><creatorcontrib>Murakami, Yosuke</creatorcontrib><creatorcontrib>Tokuhara, Daisuke</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Hepatology research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cho, Yuki</au><au>Kabata, Daijiro</au><au>Ehara, Eiji</au><au>Yamamoto, Akira</au><au>Mizuochi, Tatsuki</au><au>Mushiake, Sotaro</au><au>Kusano, Hironori</au><au>Kuwae, Yuko</au><au>Suzuki, Tsugutoshi</au><au>Uchida‐Kobayashi, Sawako</au><au>Morikawa, Hiroyasu</au><au>Amano‐Teranishi, Yuga</au><au>Kioka, Kiyohide</au><au>Jogo, Atsushi</au><au>Isoura, Yoshiharu</au><au>Hamazaki, Takashi</au><au>Murakami, Yosuke</au><au>Tokuhara, Daisuke</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessing liver stiffness with conventional cut‐off values overestimates liver fibrosis staging in patients who received the Fontan procedure</atitle><jtitle>Hepatology research</jtitle><addtitle>Hepatol Res</addtitle><date>2021-05</date><risdate>2021</risdate><volume>51</volume><issue>5</issue><spage>593</spage><epage>602</epage><pages>593-602</pages><issn>1386-6346</issn><eissn>1872-034X</eissn><abstract>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.</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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