- Email: [email protected]
394 ON-TREATMENT MONITORING OF LIVER FIBROSIS WITH TRANSIENT ELASTOGRAPHY IN CHRONIC HEPATITIS B
POSTERS (OR = 1.389, 1.142–1.689 95% CI) was significantly associated with advanced fibrosis (p < 0.001). Conclusions: TE is a simple and effective method for assessing liver fibrosis in PBC, whereas the non invasive surrogate markers failed to reveal a satisfactory performance in predicting III-IV staging. 394 ON-TREATMENT MONITORING OF LIVER FIBROSIS WITH TRANSIENT ELASTOGRAPHY IN CHRONIC HEPATITIS B H.L. Chan1 , G.L. Wong1 , P.C. Choi2 , A.W. Chan2 , V.W. Wong1 . 1 Medicine and Therapeutics, 2 Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong S.A.R. E-mail: [email protected] Background: Liver stiffness measurement (LSM) with transient elastography can accurately predict advanced liver fibrosis in treatment-naïve chronic hepatitis B (CHB) patients. Its performance to monitor the changes in the severity of liver fibrosis in CHB patients on antiviral treatment is uncertain. Methods: We prospectively studied CHB patients undergoing paired liver biopsy and transient elastography before and at week 48 of antiviral treatment. Based on our previously reported algorithm, advanced liver fibrosis (Metavir F3–4) was excluded by LSM ≤ 6.0 kPa and ≤7.5 kPa while advanced fibrosis was diagnosed by LSM >9.0 kPa and >12.0 kPa for patients with normal and elevated (>1–5 times upper limit of normal) ALT, respectively [Chan et al., J Virol Hepat 2008]. Results: Seventy-one patients (47 on clevudine; 24 on adefovir) were studied. The median change of Metavir fibrosis stage from baseline to week 48 was 0 (range −1 to 1). Seventeen and 11 patients had regression and progression of histologic fibrosis, respectively. The median ALT decreased from 99 IU/l to 33 IU/l (P < 0.0001), while the median LSM decreased from 8.8 kPa to 6.6 kPa at baseline to week 48 (P < 0.0001), respectively. Areas under receiver operating characteristics curves of LSM algorithm at baseline and week 48 for advanced (F3–4) fibrosis were 0.80 (95% CI: 0.69–0.90) and 0.78 (95% CI: 0.64–0.92), respectively. The sensitivity of LSM algorithm to exclude advanced fibrosis was 100% at baseline and 75% at week 48. The specificity of LSM algorithm to diagnose advanced fibrosis was 84% at baseline and 91% at week 48. There was a weak correlation between the change in LSM and changes in histologic staging (r = 0.25, p = 0.036). Fourteen of 29 (29%) patients with decreased LSM by ≥10%, 11 of 14 (79%) of patients with LSM change within 10% and 5 of 8 (62%) patients with LSM increased by >10% had decreased, unchanged and increased histologic stages, respectively. Conclusions: LSM could predict advanced fibrosis during antiviral therapy according to the ALT-based algorithm. Decrease in absolute LSM value, which could reflect the effect of ALT normalization, was unreliable to indicate regression of liver fibrosis. 395 AGE INFLUENCING LIVER STIFFNESS MEASUREMENTS IN CHINESE MALE GENERAL POPULATIONS Y.-P. Chen1 , X.-E. Liang1 , Q. Zhang1 , M. Dai2 , J.-L. Hou1 . 1 Infectious Diseases, 2 Nanfang Hospital, Southern Medical University, Guangzhou, China E-mail: [email protected] Background and Aims: Liver stiffness measurement (LSM) by FibroScan has been proved as a promising non-invasive method for discriminating liver fibrosis in chronic liver diseases. However, studies on normal values of liver stiffness in healthy subjects in Asian are still lacking. The aim of current study was to assess liver stiffness values in the general male population and determine potential influencing factors. S162
Methods: LSM were performed in 799 consecutive Chinese male general populations, which were undergoing a routine medical check-up. Results: Thirty seven persons (4.6%) were considered as failure in LSM due to fewer than ten successful acquisitions, or success rate lower than 60%. LSM failure rate increased with age (P = 0.000) and central obesity (P = 0.012): 12.7% in subjects with age >60 years, and 6.9% with central obesity. In 87 treatment naïve subjects with hepatitis B infection, ALT elevated (P = 0.000), eAg positive (P = 0.011) and age (P = 0.021) were the positive influencing factors for LSM. In 398 subjects with normal liver enzymes and without overt cause of liver disease, LSM in population aged more than 60 years was higher than aged 41–60 years or lower (5.9±1.9 vs 5.2±1.7, 5.2±1.5 kPa, P = 0.001). LSM was also increased with fatty liver or central obesity: 5.6±1.7 kPa vs 5.2±1.3 kPa (P = 0.032) for fatty liver and 5.5±1.6 kPa vs 5.2±1.3 kPa for central obesity (P = 0.060). LSM was also higher in subjects with AST >25 IU/L (normal range 0–45 IU/L) (5.5±1.5 kPa vs 5.1±1.3 kPa, P = 0.009). In multivariate analysis, age (regression coefficient 0.168, P = 0.001) and AST (regression coefficient 0.125, P = 0.042) were the factors influencing LSM independent of other covariates. Normal LSMs for male healthy population were 5.2±1.3 kPa (n = 343) for age ≤60 years and 5.9±1.9 kPa (n = 55) for age >60 years (P = 0.005). Conclusions: Aged population and central obesity were the main causes for LSM failure. LSM in Chinese male general population are influenced by ALT, eAg and age in hepatitis B virus infected population and influenced by age and AST in apparent healthy population, but not alcoholic consumption and mass body index. 396 ASSESSMENT OF LIVER STIFFNESS (LS) IN THE RELAPSE OF ALCOHOLIC LIVER DISEASE (RALD) AFTER LIVER TRANSPLANTATION (LT) A. Cannesson1 , H. Aftisse1 , E. Boleslawski2 , V. Canva1 , N. Declerck2 , P. Mathurin1 , F.R. Pruvot2 , S. Dharancy1 . 1 Hepatology Unit, 2 Transplant Unit, CHRU Lille, Lille, France E-mail: [email protected] Assessment of liver stiffness (LS) using Fibroscan is a validated non-invasive method evaluating fibrosis in alcoholic liver disease (ALD). Its feasibility and interest are unknown in the relapse of ALD (RALD) after liver transplantation (LT). Aims: 1. to evaluate acceptability and feasibility of LS assessment in RALD and 2. to determine whether LS was associated with RALD after LT. Patients and Methods: All the patients transplanted for ALD were convened for a measurement of LS and liver functional tests. Value of stiffness was considered as interpretable for a number of valid measures upper 8. Patients were classified according to WHO recommendation as abstinent, occasional drinker or heavy drinker after specific evaluation. Some transplanted patients underwent liver biopsy to evaluate fibrosis. Statistical analysis used Chi-square and Mann-Whitney tests. Survival was estimated using Kaplan– Meier method. Results: Between 1986 and 2006, 148 patients were transplanted for ALD. The 10-years survival was at 62±6.5%. 114 patients were convened and 93 underwent LS measurement (80% of acceptability). The rate of success of the LS measurement was conversely correlated with the body mass index (correlation −0.62, p < 0.0001) and the median BMI was at 27 kg/m2. The measure of LS was analyzable in 66 patients (44 males/22 females, mean age 55±6 years) giving a rate of interpretability at 71%. 58 patients were abstinent or occasional drinker (87% of the population) and 8 patients were heavy drinkers (12 % of the cases) after a mean followup of 5.4±3.4 years. Heavy drinkers had a significant increase of liver tests (AST: 35.4 vs 22.7 UI/l, p = 0.01; GGT: 79 vs 39 UI/l,
Journal of Hepatology 2010 vol. 52 | S59–S182
Methods: LSM were performed in 799 consecutive Chinese male general populations, which were undergoing a routine medical check-up. Results: Thirty seven persons (4.6%) were considered as failure in LSM due to fewer than ten successful acquisitions, or success rate lower than 60%. LSM failure rate increased with age (P = 0.000) and central obesity (P = 0.012): 12.7% in subjects with age >60 years, and 6.9% with central obesity. In 87 treatment naïve subjects with hepatitis B infection, ALT elevated (P = 0.000), eAg positive (P = 0.011) and age (P = 0.021) were the positive influencing factors for LSM. In 398 subjects with normal liver enzymes and without overt cause of liver disease, LSM in population aged more than 60 years was higher than aged 41–60 years or lower (5.9±1.9 vs 5.2±1.7, 5.2±1.5 kPa, P = 0.001). LSM was also increased with fatty liver or central obesity: 5.6±1.7 kPa vs 5.2±1.3 kPa (P = 0.032) for fatty liver and 5.5±1.6 kPa vs 5.2±1.3 kPa for central obesity (P = 0.060). LSM was also higher in subjects with AST >25 IU/L (normal range 0–45 IU/L) (5.5±1.5 kPa vs 5.1±1.3 kPa, P = 0.009). In multivariate analysis, age (regression coefficient 0.168, P = 0.001) and AST (regression coefficient 0.125, P = 0.042) were the factors influencing LSM independent of other covariates. Normal LSMs for male healthy population were 5.2±1.3 kPa (n = 343) for age ≤60 years and 5.9±1.9 kPa (n = 55) for age >60 years (P = 0.005). Conclusions: Aged population and central obesity were the main causes for LSM failure. LSM in Chinese male general population are influenced by ALT, eAg and age in hepatitis B virus infected population and influenced by age and AST in apparent healthy population, but not alcoholic consumption and mass body index. 396 ASSESSMENT OF LIVER STIFFNESS (LS) IN THE RELAPSE OF ALCOHOLIC LIVER DISEASE (RALD) AFTER LIVER TRANSPLANTATION (LT) A. Cannesson1 , H. Aftisse1 , E. Boleslawski2 , V. Canva1 , N. Declerck2 , P. Mathurin1 , F.R. Pruvot2 , S. Dharancy1 . 1 Hepatology Unit, 2 Transplant Unit, CHRU Lille, Lille, France E-mail: [email protected] Assessment of liver stiffness (LS) using Fibroscan is a validated non-invasive method evaluating fibrosis in alcoholic liver disease (ALD). Its feasibility and interest are unknown in the relapse of ALD (RALD) after liver transplantation (LT). Aims: 1. to evaluate acceptability and feasibility of LS assessment in RALD and 2. to determine whether LS was associated with RALD after LT. Patients and Methods: All the patients transplanted for ALD were convened for a measurement of LS and liver functional tests. Value of stiffness was considered as interpretable for a number of valid measures upper 8. Patients were classified according to WHO recommendation as abstinent, occasional drinker or heavy drinker after specific evaluation. Some transplanted patients underwent liver biopsy to evaluate fibrosis. Statistical analysis used Chi-square and Mann-Whitney tests. Survival was estimated using Kaplan– Meier method. Results: Between 1986 and 2006, 148 patients were transplanted for ALD. The 10-years survival was at 62±6.5%. 114 patients were convened and 93 underwent LS measurement (80% of acceptability). The rate of success of the LS measurement was conversely correlated with the body mass index (correlation −0.62, p < 0.0001) and the median BMI was at 27 kg/m2. The measure of LS was analyzable in 66 patients (44 males/22 females, mean age 55±6 years) giving a rate of interpretability at 71%. 58 patients were abstinent or occasional drinker (87% of the population) and 8 patients were heavy drinkers (12 % of the cases) after a mean followup of 5.4±3.4 years. Heavy drinkers had a significant increase of liver tests (AST: 35.4 vs 22.7 UI/l, p = 0.01; GGT: 79 vs 39 UI/l,
Journal of Hepatology 2010 vol. 52 | S59–S182