Non-invasive biomarkers of liver fibrosis in liver transplant patients with hepatitis C: Can we avoid liver biopsies?

Abstract

HCV-related end-stage liver disease is the main indication for liver transplantation (LT) in most centers. Unfortunately, recurrent HCV infection is the rule with most patients developing post-transplantation HCV-graft disease. In fact, the deposition of fibrotic tissue in the new liver is a process that takes place more rapidly than it does in the native liver [ [1] Samuel D. Forns X. Berenguer M. Trautwein C. Burroughs A. Rizzetto M. et al. Report of the monothematic EASL conference on liver transplantation for viral hepatitis (Paris, France, January 12–14, 2006). J Hepatol. 2006; 45: 127-143 Abstract Full Text Full Text PDF PubMed Scopus (142) Google Scholar ]. The liver biopsy is the gold standard to assess the severity and progression of liver damage, including the degree of necro-inflammation and stage of fibrosis, and to exclude additional pathologies. Several histological scores are used, including the Knodell index, and its modified version by Ishak and METAVIR, with no evidence of superiority for any of these scores [ [2] Dienstag J. The role of liver biopsy in chronic hepatitis C. Hepatology. 2002; 36: S152-S160 Crossref PubMed Google Scholar ]. In the last few years, a search for non-invasive assessment of liver fibrosis has emerged, as a result of the increased awareness of the limitations of liver biopsies [ 2 Dienstag J. The role of liver biopsy in chronic hepatitis C. Hepatology. 2002; 36: S152-S160 Crossref PubMed Google Scholar , 3 Poynard T. Morra R. Ingiliz P. Imbert-Bismut F. Thabut D. Messous D. et al. Biomarkers of liver fibrosis. Adv Clin Chem. 2008; 46: 131-160 Crossref PubMed Scopus (57) Google Scholar ]. Indeed, major complications and liver-biopsy mortality have a prevalence of 0.15 and 0.01%, respectively. These data though come from early studies performed in immune competent patients, and similar information in LT is mostly missing. Additional limitations include the cost, inter- and intra-variability, sampling error, and particularly the fact that a biopsy provides a static picture of fibrosis while this is a very dynamic process [ [4] Friedman S.L. Rockey D.C. Bissell D.M. Hepatic fibrosis 2006: report of the Third AASLD Single Topic Conference. Hepatology. 2007; 45: 242-249 Crossref PubMed Scopus (98) Google Scholar ]. In addition, as the efficacy of antiviral drugs increase, the impact of histologic findings on therapeutic decisions is also questioned.