J Pediatr Gastroenterol Nutr. 2012 Aug 23. [Epub ahead of print]

Journal of Pediatric Gastroenterology & Nutrition:

January 2013 - Volume 56 - Issue 1 - p 72–76

doi: 10.1097/MPG.0b013e31826f2760

Original Articles: Hepatology and Nutrition

Transient Elastography Is A Useful Non-Invasive Tool For The Evaluation of Fibrosis In Paediatric Chronic Liver Disease.

Fitzpatrick E, Quaglia A, Vimalesvaran S, Basso MS, Dhawan A.

Source

*Paediatric Liver, GI and Nutrition Centre, King's College London School of Medicine at King's College Hospital †Institute of Liver Studies, King's College London School of Medicine at King's College Hospital ‡Department Paediatric Gastroenterology and Hepatology, Bambino de Jesu, Rome, Italy.

Abstract

BACKGROUND:: Outcome of liver disease in children is mainly determined by severity and progression of liver fibrosis. Liver biopsy is the accepted standard for evaluating fibrosis but is limited by the need for sedation in children, sampling error and risks including bleeding. The aim of this study was to compare tools for noninvasive assessment of liver fibrosis in a paediatric cohort. METHODS:: Children undergoing liver biopsy for chronic liver disease were recruited and underwent transient elastography (TE). Liver biopsies were scored by a hepato-histopathologist from F0 (no fibrosis) to F4 (cirrhosis). TE was compared to biopsy score.

RESULTS: During the study period 104 children (62 boys) were enrolled. Median age: 13.6 years. Diagnosis was autoimmune liver disease in 27; non-alcoholic fatty liver disease in 37; 16 children were post-transplant; 8 children had Hepatitis B/C; 5 had Wilson disease and the remainder miscellanous. TE was successful in all but 7 patients and was a good discriminator of significant fibrosis (≥F2) (p < 0.001), severe fibrosis (≥F3) (p < 0.001) and cirrhosis (F4) (p = 0.003). The area under the receiver operating characteristic curve for the prediction of ≥F2, ≥F3 and F4 using TE were 0.78, 0.79 and 0.96 respectively. TE performed best in children autoimmune liver disease and in those post-transplant.

CONCLUSION: This study demonstrates that TE is a reliable tool in distinguishing different stages of liver fibrosis in paediatric patients. Thus TE may serve as a useful adjunct to liver biopsy for diagnostic purposes providing a reliable method of non-invasively monitoring liver disease progression in children.

PMID: 22922372 [PubMed - as supplied by publisher]