Liver Elastography Research Articles

Liver Elastography for Complementary Assessment of Heart Failure

Liver Elastography for Complementary Assessment of Heart Failure

Obesity and Body Composition in Relation to Liver and Kidney Ultrasound Elastography in Paediatric Patients with Either Hypertension or Chronic Kidney Disease.

(1) Background: Ultrasound elastography is a novel ultrasound technique for evaluating tissue elasticity. One of the key factors influencing the measurement in children is excess weight. This study aimed to evaluate the effect of body composition, namely, fat mass, on liver and kidney ultrasound elastography in paediatric patients. (2) Methods: 114 participants, in whom bioimpedance, along with liver and kidney ultrasound elastography, were performed, were included (37 patients with chronic kidney disease, 46 patients with hypertension, and 31 healthy subjects). (3) Results: Bioimpedance analysis showed a significant correlation between liver elastography parameters and the phase angle (p = 0.002), fat-free mass (p = 0.001), body cell mass (p = 0.001), total body water (p = 0.001), extracellular water (p = 0.006), and, to lesser extent, fat mass (p = 0.041). On the contrary, kidney elastography parameters strongly correlated only with fat mass (p < 0.001 for both kidneys). (4) Conclusions: Liver and kidney stiffness increased in overweight participants and showed significant correlation with fat mass, particularly in the case of kidney elastography.

Prevalence and Crucial Parameters in Diabesity-Related Liver Fibrosis: A Preliminary Study.

Diabetes and obesity have been recognized as confirmed risk factors for the occurrence of liver fibrosis. Despite the long-standing acknowledgment of "diabesity", the simultaneous existence of diabetes and obesity, scholarly literature has shown limited attention to this topic. The aim of this pilot study was to assess the prevalence of liver fibrosis among individuals with diabetes (specifically those who are obese) in order to identify the key factors associated with hepatofibrosis and determine the most important associations and differences between patients with and without liver fibrosis. The research included a total of 164 participants (48.17% had comorbid obesity). Liver elastography (Fibroscan) was performed on these individuals in addition to laboratory tests. Liver fibrosis was found in 34.76% of type 2 diabetes patients; male gender almost doubled the risk of hepatofibrosis (RR 1.81) and diabesity nearly tripled this risk (RR 2.81; however, in degree III of obesity, the risk was elevated to 3.65 times higher). Anisocytosis, thrombocytopenia, or elevated liver enzymes raised the incidence of liver fibrosis by 1.78 to 2.47 times. In these individuals, liver stiffness was negatively correlated with MCV, platelet count, and albumin concentration; GGTP activity and HbA1c percentage were positively correlated. The regression analysis results suggest that the concentration of albumin and the activity of GGTP are likely to have a substantial influence on the future management of liver fibrosis in patients with diabesity. The findings of this study can serve as the basis for subsequent investigations and actions focused on identifying potential therapeutic and diagnostic avenues.

∆4-3-oxo-5β-reductase deficiency: favorable outcome in 16 patients treated with cholic acid

BackgroundOral cholic acid therapy is an effective therapy in children with primary bile acid synthesis deficiencies. Most reported patients with this treatment have 3β-hydroxy-Δ5-C27-steroid oxidoreductase deficiency. The aim of the study was the evaluation of cholic acid therapy in a cohort of patients with the rarer Δ4-3-oxosteroid 5β-reductase (Δ4-3-oxo-R) deficiency.MethodsSixteen patients with Δ4-3-oxo-R deficiency confirmed by AKR1D1 gene sequencing who received oral cholic acid were retrospectively analyzed.ResultsFirst symptoms were reported early in life (median 2 months of age), with 14 and 3 patients having cholestatic jaundice and severe bleeding respectively. Fifteen patients received ursodeoxycholic acid before diagnosis, with partial improvement in 8 patients. Four patients had liver failure at the time of cholic acid initiation. All 16 patients received cholic acid from a median age of 8.1 months (range 3.1–159) and serum liver tests normalized in all within 6–12 months of treatment. After a median cholic acid therapy of 4.5 years (range 1.1–24), all patients were alive with their native liver. Median daily cholic acid dose at last follow-up was 8.3 mg/kg of body weight. All patients, but one, had normal physical examination and all had normal serum liver tests. Fibrosis, evaluated using liver biopsy (n = 4) or liver elastography (n = 9), had stabilized or improved. Cholic acid therapy enabled a 12-fold decrease of 3-oxo-∆4 derivatives in urine. Patients had normal growth and quality of life. The treatment was well tolerated without serious adverse events and signs of hepatotoxicity.ConclusionsOral cholic acid therapy is a safe and effective treatment for patients with Δ4-3-oxo-R deficiency.

КЛИНИЧЕСКИЙ СЛУЧАЙ IGG4-АССОЦИИРОВАННОГО ПАНКРЕАТИТА

Abstract. Introduction. IgG4-associated pancreatitis is a rare chronic autoimmune disease characterized by pancreas infiltration with IgG4 cells and by an increased IgG4 level in blood serum. Aim. Present a clinical case of IgG4-associated pancreatitis. Materials and Methods. A clinical case is presented, describing IgG4-associated pancreatitis in a 22-year- old male patient. Results and Discussion. During the examination, the following conditions were excluded: Autoimmune liver diseases (ANA, ASMA IgG, LKM-1 IgG – negative, according to liver elastography, fibrosis 0) and primary sclerosing cholangitis (based on magnetic resonance cholangiopancreatography). Pancreas dimensions were enlarged (according to computed tomography: 41.5x29x36.5 mm, smoothed lobulation; hepatosplenomegaly, intraperitoneal lymphadenopathy, and ascites minor). Against the treatment (Mesalazine, Ferrum Lek, and prednisolone 60 mg intravenously, with a transition of 50 mg per day inside), positive changes were noticed (body temperature normalized, daily stool frequency decreased). Conclusions. The case presented demonstrates the difficulties in diagnosing IgG4-associated diseases. Combination of ulcerative colitis and IgG4-associated pancreatitis described in this paper further complicates the differential diagnostic search, but at the same time, it does not exclude possible common pathogeneses of various autoimmune diseases in this group of patients.

Adult Patients with Hemophilia B and with a History of Chronic HCV/HBV Infection Receiving Liver-Directed Gene Therapy Demonstrated Long-Term Bleeding Protection and Sustained FIX Activity: Efficacy and Safety Results from the HOPE-B Trial 3 Years after Administration of a Single Dose of Etranacogene Dezaparvovec

Introduction: Liver-targeted recombinant adeno-associated virus (rAAV) gene therapy for hemophilia B has recently become a real-world therapeutic option for an adult population burdened with prevalent co-morbid chronic hepatitis C virus (HCV) and hepatitis B virus (HBV). The pivotal phase 3 HOPE-B trial (NCT03489291) evaluated the efficacy and safety of etranacogene dezaparvovec (CSL222, formerly AMT-061), an AAV5 vector, containing a codon-optimized, highly active factor IX (FIX) Padua R338L transgene under the control of the liver-specific promoter LP-1. Here we evaluate the efficacy and safety of etranacogene dezaparvovec in the subset of HOPE-B participants with a history of chronic HCV and/or HBV. Methods: Adult male participants with hemophilia B (FIX ≤2%), were infused with a single dose of etranacogene dezaparvovec (2x10 13 gc/kg), following a ≥6-month lead-in period receiving their usual FIX prophylaxis. Relevant exclusion criteria included baseline liver chemistries &amp;gt; 2X the upper limit of normal (ULN); active HCV (HCV RNA detectable), HBV (HBV DNA detectable or HBV sAg reactive) or uncontrolled HIV infection; or advanced liver fibrosis (FibroScan™ score of ≥9 kPa). Regular liver ultrasound screening, serum chemistries, and alphafetoprotein (AFP) were collected along with FIX expression and bleeding data. During the first months post-treatment, alanine aminotransferase (ALT) increase to 2X the subject's baseline or &amp;gt;ULN was treated with a per-protocol tapering course of oral corticosteroids. Results: Among 54 HOPE-B trial participants, 31 (57.4%) had history of co-morbid chronic HCV, without active disease and with undetectable HCV RNA. Of these 31 subjects, 7 had a history of chronic HBV infection without active disease (HBV DNA undetectable; HBV sAg neg). Two subjects were HCV/HIV co-infected (HIV DNA neg; CD4+ T-cell count &amp;gt;200). Two subjects were HBV+ (HBV env AB reactive, HBV sAg non-reactive, HBV DNA undetectable)/HCV-/HIV-. The mean age in the HCV+ and/or HBV+ subgroup (HCBV n=33) was 50.0 years (range 31-75). All HCBV participants had central lab (CL) ALT &amp;lt;ULN (ULN=41 U/L) on the day of dosing except one subject who had a CL ALT of 48 U/L. The mean screening fibroscan (liver elastography) score for this subgroup was 5.2 kPa (range 2.8-8.0). In HCBV participants 16/33 (48.5%) had pre-existing AAV5 neutralizing antibodies (NAb), with titers ranging from 8.5-3232; all NAb+ HCBV patients had titer ≤678 except one participant who had a titer of 3212 and never demonstrated FIX expression; as a result his prophylactic FIX infusions were never discontinued and his efficacy outcomes reflect exogenous FIX therapy. One HCBV participant returned to continuous routine prophylaxis 30 months post treatment. In the HOPE-B trial 11/54 (20.4%) of participants had 12 adverse events of ALT elevation of 2X above baseline or &amp;gt;ULN within 12 weeks after etranacogene dezaparvovec treatment, which triggered immunosuppressive therapy with corticosteroids in 9/54 (16.7%) participants. In the HCBV subgroup, 5/33 (15.2%) participants had ALT elevations of which 4/33 (12.1%) participants received corticosteroids. As reported previously (Schmidt M, et al. Blood Advances. 2023), one HCBV subject maintained normal AFP levels however per-protocol screening ultrasound at one year after gene therapy this participant developed a hepatocellular carcinoma (HCC); molecular characterization demonstrated the HCC was not related to etranacogene dezaparvovec treatment. Factor IX expression was stably increased above baseline throughout 36 months after the single CSL222 infusion. History of chronic HCBV did not impact FIX expression (Table 1). After excluding the subject with the pre-existing AAV5 NAb titer 3212 whose continued prophylaxis use confounds analysis, the mean annualized bleeding rate (ABR) decreased after gene therapy compared to lead-in standard of care FIX prophylaxis. HCBV participants demonstrated an ABR rate ratio of 0.31 (95% CI 0.13, 0.72) indicating 69% reduction in all bleeding, sustained from months 7-36 following etranacogene dezaparvovec treatment. Conclusions: The majority of HOPE-B trial participants were adults with a history of chronic HCV and/or HBV infection without active viral disease or evident pre-existing liver fibrosis. Safety and efficacy are observed in the HCBV participants.

Comparison of spin-echo echo planar imaging and gradient-recalled echo sequences in magnetic resonance elastography of liver at 1.5T same MRI scanner.

Magnetic resonance elastography (MRE) is used to measure liver stiffness with gradient-recalled echo (GRE)-based and spin-echo echo planar imaging (SE-EPI)-based sequences. We compared the liver stiffness (LS) values of the two sequences on a 1.5-T MR imaging scanner. This is a retrospective study. An MRE imaging section was obtained from a horizontal section of the liver. Region of interest was drawn on the elastogram, and the mean LS and pixel values were measured and compared. The correlations between proton density fat fraction, R2* values, and biochemical data from electronic medical records were confirmed, and multivariate analysis was performed. The mean LS values were 3.01±1.78kPa for GRE and 3.13±1.57kPa for SE-EPI, showing excellent agreement and a strong correlation between the two sequences (correlation coefficient r=0.96). The mean pixel values were 369.5±142.7 pixels for GRE and 490.1±197.9 pixels for SE-EPI, showing a significant difference by the Wilcoxon rank sum test (p<0.01). There were no LS unmeasurable cases in SE-EPI, but seven (2.5%) were unmeasurable in GRE, and multivariate analysis showed a significant difference with p<0.001 in R2* values (mean, 92.7Hz) for the GRE method. The GRE and SE-EPI methods were comparable for LS measurements in 1.5-T liver MRE, indicating that SE-EPI MRE is more useful because GRE MRE may not measure cases with high R2* values and the region of interest tends to be smaller.

Effects of sodium-glucose contrasporter-2 inhibitors and glucagon-like peptide-1 receptor agonists on vascular function and liver steatosis in diabetes

Abstract Background/Introduction Patients with type-2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) present increase risk of cardiovascular disease. Sodium-glucose contrasporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have been shown to significantly reduce the risk of cardiovascular complications. Purpose The aim of the study was to investigate the effect of treatment with SGLT-2i or GLP-1RA on vascular function and liver steatosis and fibrosis in patients with T2DM and NAFLD. Methods Thirty patients with T2DM and NAFLD (mean age: 57±11 years) were randomized to receive SGLT-2i (dapagliflozin; n=15) or GLP-1RA (dulaglutide; n=15). At baseline and at 6 months post-treatment, we measured: (1) Perfused boundary region (PBR) of the sublingual microvessels with a diameter 5-25μm using Sidestream Dark Field camera (Microscan, Glycocheck). Increased PBR indicates reduced glycocalyx thickness. (2) Pulse wave velocity (PWV) and augmentation index (AI) using Complior (ALAM Medical), (3) NAFLD fibrosis score (NFS), and (4) Controlled attenuation parameter (CAP) score to assess steatosis grade and liver stiffness (E) to evaluate fibrosis score using liver elastography (FibroScan, Echosens). Results At baseline, patients between the two groups had similar age, sex, HbA1c, steatosis grade, fibrosis score and markers of vascular function (p&amp;gt;0.05). Compared with baseline, all patients had reduced PBR, PWV, AI, NFS, CAP and E (p&amp;lt;0.05) after 6-month treatment. In the whole study population, the percentage reduction of markers of steatosis (NFS) correlated with the corresponding decrease in PBR (r=0.34, p=0.040) and PWV (r=0.31, p=0.043) post-treatment. Both treatments with SGLT-2i and GLP-1RA reduced markers of liver steatosis and fibrosis (Table). Conclusion Both treatments with SGLT-2i and GLP-1RA improve vascular function and reduce liver steatosis in patients with T2DM and NAFLD after 6-month treatment.Table

Abstract 12727: Liver Elasticity in Elderly Heart Failure Patient

Introduction: Liver elastography is a novel ultrasound technique assessing elasticity of liver tissue. Clinical indication of liver elastography remains unrevealed. Moreover, reports about relationship between liver stiffness and heart failure subtypes haven’t well been published. Hypothesis: We have investigated the cardio-hepatic interaction using liver elastography in heart failure subtypes. Methods: We prospectively enrolled 58 consecutive patients with heart failure admission from April 2022 to March 2023. Liver elastography, transthoracic echocardiography and blood sampling were done at the time of discharge from heart failure treatment. Results: Patients were divided into two groups according to the left ventricular ejection fraction (LVEF) of echocardiography: heart failure with reduced ejection fraction (HFrEF) group (EF ≦40%, n = 11) and non-HFrEF group (EF &gt;40%, n = 31). The mean age of all patients was 83 ± 11 years. The mean age and the prevalence of hypertension and diabetes mellitus was higher in non-HFrEF group than in HFrEF group. The prevalence of taking sodium glucose co-transporter 2 (SGLT2) inhibitors was lower in non-HFrEF group than in HFrEF group. LV end-diastolic diameter, LV end-systolic diameter was larger in HFrEF group than in non-HFrEF group. Tricuspid regurgitation pressure gradient (TRPG) was higher in non-HFrEF group than in HFrEF group. Inferior vena cava diameter was not different between two groups. The mean values of almost liver function tests of all patients were within the normal range. eGFR was lower in non-HFrEF group than in HFrEF group. Liver elasticity was higher in non-HFrEF group than in HFrEF group (7.1 ± 2.7 vs. 5.1 ± 1.5 hPa; P=0.008) indicating liver stiffness. Pearson’s correlation coefficient showed that liver elasticity was positively correlated with the prevalence of diabetes mellitus, LVEF, TRPG, serum creatinine, aspartate aminotransferase, γ-glutamyl transpeptidase and was negatively correlated with LV end-diastolic diameter, LV end-systolic diameter. Conclusions: Liver stiffness was elevated in EF-preserved heart failure patients. Liver elasticity was correlated with parameters of congestion (TRPG) and useful for the assessment of congestion in patients with heart failure.

Elastography and Steatometry of the Liver from the Position of World Experts 2018–2022

Purpose: To evaluate the dynamics of the opinions of world experts on the materials of world recommendations on ultrasound elastography and liver steatometry from the standpoint of the domestic level of development of ultrasound diagnostics and on the basis of our own data.Material and methods: 16 main provisions of the World Guidelines for Liver Elastography in 2018 were reviewed and comments were made, differences from the European Guidelines of 2017 and the first World Guidelines of 2015 were noted. We reviewed and commented on the 2020 SRU comments. The final scientific publication of a large group of world experts in 2022 is analyzed in detail, where for the first time the norms and threshold values between benign and malignant neoplasms of a large number of human organs and tissues are given.Results: From 2006 to the present, more than 45,000 ultrasound studies have been carried out on our own material (n=15627), some differences in approaches to liver elastometry are given, and approaches to the use of ultrasound steatometry are considered.Conclusion: Threshold development vectors are shown, techniques to avoid artifacts and reduce the risk of obtaining false negative and false positive elastometry results are proposed. There is caution of the expert community in the review of the method of quantitative steatometry based on the measurement of the attenuation coefficient of the ultrasound wave.

S1585 Diagnostic Accuracy of Point of Care Liver Elastography for Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis

S1585 Diagnostic Accuracy of Point of Care Liver Elastography for Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis

Sequence gene variants in PPARGC1A rs8192678, PPARG2 rs1801282, FTO rs9939609, LEP rs7799039, LEPR rs1137101 and nonalcoholic fatty liver disease

Objective: to evaluate the association of sequence variants PPARGC1A rs8192678, PPARG2 rs1801282, FTO rs9939609, LEP rs7799039, LEPR rs1137101 with non-alcoholic fatty liver disease (nAFLD) at young adults in Russian population. Material and methods. The case-control study included 100 patients divided into two groups: group 1 (cases) — with nAFLD (n=50); group 2 (controls) without nAFLD (n=50). All subjects underwent a standard ultrasound examination of the liver and ultrasound shear wave elastography (Aixplorer, France) with an assessment of the severity of liver steatosis and fibrosis. Results. We found two sequence variants associated with an increased risk of nAFLD in women: rs9939609 and rs7799039: A/A rs9939609 genotype (OR 5,33; 95% Cl 1,14-24,90; p=0,041) and G/G genotype rs7799039 (OR 7,5; 95% Cl 1,04-54,12; p=0,026). Conclusion. The A/A genotype ofthe rs9939609 gene in young women in the Russian population increased the chance of having nAFLD by 5 times, the G/G genotype ofthe rs7799039 gene increased the chance of having nAFLD by 7.5 times.

Assessment of focal liver lesions in non-cirrhotic liver – expert opinion statement by the Swiss Association for the Study of the Liver and the Swiss Society of Gastroenterology

Focal liver lesions are common, with a prevalence up to 20%. The lesions must be evaluated in context of risk factors associated with malignancy. Risk factors include age &gt;40 years, known current or past malignancy, presence of liver cirrhosis or chronic liver disease (i.e. suspected by elevated liver elastography measurement ≥8 kPa or FIB-4 score ≥1.3), unintentional weight loss, fever or night sweats, newly detected focal liver lesions, documented growth of focal liver lesions, current or past use of androgens (e.g. testosterone, oxymetholone, danazol), increased serum tumour markers (i.e. alpha-fetoprotein, carbohydrate antigen 19-9 [CA19-9], carcinoembryonic antigen [CEA]) and family history of malignancy. In patients without risk factors of malignancy, regional (non-)fatty changes, simple liver cysts and typical haemangiomas can be diagnosed by conventional ultrasound (without contrast). Conventional ultrasound Doppler is recommended to rule out vascular malformations such as portosystemic shunts. In all other cases of focal liver lesions, contrast-enhanced imaging is indicated for differentiation in benign and malignant dignity. Contrast-enhanced ultrasound (CEUS) as a first diagnostic step and contrast-enhanced magnetic resonance imaging (MRI) are accurate tests to diagnose haemangioma and focal nodular hyperplasia. Hepatocellular adenoma is diagnosed by contrast-enhanced MRI and/or histology. “Wash out” on CEUS is highly suspicious for a malignant focal liver lesion. Additional investigations aimed at identifying the primary tumour, as well as staging-computed tomography, MRI and/or histology may be necessary and should be decided on a case-by-case basis. A biopsy of focal liver lesions is indicated in cases of unclear dignity, malignant aspect and focal liver lesions of unclear origin as well as for guiding surgical and oncological management.

Liver stiffness in Fontan patients: the effect of respiration and food intake.

For several years, patients with single ventricle hearts have been palliated according to the Fontan principle. One well known long-term consequence in these patients is the Fontan-associated liver disease and fibrosis, which occurs due to the chronically increased Central Venous Pressure (CVP) after Fontan palliation. It carries an increased risk of liver cirrhosis and hepatocellular carcinoma over time. Liver elastography (LE) is a non-invasive, safe, and feasible ultrasound method to determine liver stiffness and the stage of liver fibrosis. Usually, this examination must be performed in a sober condition and strict inspiratory hold to optimize the results and may therefore be difficult to perform on children as a routine examination. However, the influence of food intake and respiration on these results in Fontan patients is unclear. To optimize the implementation for this examination especially in children, the effects of food intake and breathing maneuvers on liver stiffness in patients with Fontan circulation were investigated. For this prospective study, 25 Fontan patients (group 1) and 50 healthy volunteers (group 2) were examined. The two groups were additionally divided into two age categories (group 1a: 10-19 years; group 1b: 20-29 years; group 2a: 15-19 years; group 2b: 20-25 years). Liver stiffness was measured by liver elastography once before food intake (=T0, with 6 h of fasting). Subsequently the participants consumed a standardized chocolate drink (500 mL) with nutritional distribution corresponding to a standardized meal (600 kcal). Liver stiffness was then determined 15, 30, 45, 60, 90, 120, 150, and 180 min after ingestion. Each measurement of liver stiffness was performed during maximal inspiratory and expiratory holds. The study was reviewed and approved by the responsible ethics committee. In group 2 there was a significant increase in liver stiffness after food intake at T15, T30, and T45 during inspiration measurements (T0 = 4.0 kPa vs. T15 = 4.9 kPa, difference = 22.5%; T0 = 4.0 kPa vs. T30 = 4.9 kPa difference = 22.5%; T0 = 4.0 kPa vs. T45 = 4.3 kPa difference = 7.5%), as well as during expiration at T15 and T30 (T0 = 4.5 kPa vs. T15 = 5.1 kPa, difference = 14.7%; T0 = 4.5 kPa vs. T30 = 4.9 kPa difference = 7.8%). Whereas in Fontan patients (group 1) liver stiffness did not differ significantly at any time between fasting (T0) and postprandial values. The respiratory maneuvers in the healthy subjects (group 2) differed significantly only before food intake (T0) (group 2: insp = 3.97 kPa vs. exp. = 4.48 kPa difference = 11.3%). In the Fontan group (group 1), there was no significant difference between the respiratory phases at any point. The different age categories showed no significant difference in liver stiffness. With these results we could demonstrate for the first time that in Fontan patients the time of food intake (i.e., fasting) has no clinical significance for the values obtained in liver elastography. We could also demonstrate that the breathing maneuvers during the examination had only minimal clinical impact on the results of liver elastography in patients with normal circulation and no effect in patients with Fontan-circulation. Consequently, liver elastography for Fontan patients is reliable independently of food intake and breathing maneuvers and can also be performed on younger patients, who are unable to follow breathing commands or longer fasting periods, without any impairment of the results. These results should encourage a routine use of LE in the follow-up of Fontan patients.

Spleen stiffness: a new tool to predict high-risk varices in cirrhotic patients.

Cirrhosis is one of the major causes of morbidity and mortality worldwide. Portal hypertension is the major contributor of cirrhosis-related complications and is defined as a hepatic venous pressure gradient (HVPG)>5mmHg. Measurement of HVPG is an invasive, difficult, and costly procedure. Therefore, it is only performed in specialized centers. Liver stiffness measured with transient elastography is one of the most studied noninvasive markers of portal hypertension, and spleen elastography has recently emerged as an important adjuvant tool. The development of a new probe (100Hz) that more reliably reflect the grade of portal hypertension evaluated by spleen stiffness measurement has improved the accuracy of this technique. The aim of this work was to evaluate the accuracy of spleen stiffness with the new dedicated probe to predict the presence of high-risk varices, as well as to determine the ideal cutoff to predict it. Prospective study of cirrhotic patients admitted to upper endoscopy that were also submitted to liver and spleen elastography with the 100-Hz probe by the same blinded operator in a tertiary center. We included 209 cirrhotic patients, with mean age of 61.9years (±9.9), 77.0% male. The most common etiology was alcoholic liver disease (72.7%). The median value of liver elastography was 25.3 [4.5-75] kPa, and the median value of spleen elastography was 42.4 [7.6-100] kPa. At the cutoff of 53.25kPa, we obtained sensitivity of 100% and specificity of 72.6% to predict high-risk varices, and, according to this cutoff, 133/175 of esophagogastroduodenoscopy could have been spared (76.0%), while according to Baveno guidelines, only 51/175 would have been spared (29.1%). In the era of noninvasive exams, spleen elastography with the 100-Hz probe emerges as an excellent tool for prediction of presence of high-risk varices. At the cutoff of 53.25kPa, spleen elastography avoids upper endoscopy for screening for high-risk varices, promising to be become part of the hepatologists' daily routine.

Transient liver elastography in the follow-up of Fontan patients: results of a nation wide survey in Germany.

Fontan-palliated patients are at risk for the development of Fontan-associated liver disease (FALD). Currently, there is no consensus on how to stage FALD. Transient elastography (TE) is a rapid, non-invasive method to assess FALD and liver fibrosis. To assess the availability and conditions of using TE to monitor liver disease in Fontan patients in german centers for pediatric cardiology and to propose the introduction of a standardized national protocol for the monitoring of liver disease, we developed a questionnaire. In total, 95 valid questionnaires were collected. Only 20% of the centers offer the TE investigation directly. Most of the centers transfer the patients to another department or center (40%) or didńt offer TE (40%). In only 2.6% of the centers TE is performed directly by the cardiologist. Most of the centers transfer the patients to a other department. In 29.2% TE is performed only at a certain age of the patients and in 27.7% it is performed if the patients present symptoms of failing Fontan. In only 13.9% of the centers TE is proposed in all the Fontan patients on a routine basis. Most often TE is performed only from the beginning of the adolescence. In the majority of answers it was not known if the patients are fasting for the examination (68%) or not and if the TE examination had to be performed in a specific breathing phase during TE (Inspiration/Expiration, 90%). In the majority, TE is not offered routinely (46.9%). To date in Germany, TE is only used in a few numbers of centers specialized in Fontan follow-up. A standardized protocol to use TE is currently not existing. With regard to the feasibility of the examination, it is evident that TE is a quick, cheap and easy method to distinguish between cases with and without progressive FALD. This makes TE a useful and prognostic tool for screening of liver disease and to failing Fontan circulation. We propose a systematic TE evaluation of possible liver congestion and fibrosis, as a part of the routine follow-up of Fontan patients.

Changes in weight, body composition and metabolic parameters after switch to dolutegravir/lamivudine compared with continued treatment with dolutegravir/abacavir/lamivudine for virologically suppressed HIV infection (The AVERTAS trial): a randomised, open-label, superiority trial in Copenhagen, Denmark

IntroductionWith longer life expectancy in people living with HIV (PLWH) on antiretroviral therapy, cardiovascular disease (CVD) has become a common cause of mortality among them. Abacavir has been associated with...

Portal hypertension syndrome in children with autosomal recessive polycystic kidney disease with liver cysts and hepatic fibrosis

Hepatic fibrosis, liver cysts, and portal hypertension are extrarenal manifestations that determine the prognosis of autosomal recessive polycystic kidney disease in children.Purpose. To assess the features of the manifestation and course of liver cystic disease and fibrosis, the development of portal hypertension in the follow-up medical history of children with autosomal recessive polycystic kidney disease.Material and methods. We studied 27 children with autosomal recessive polycystic kidney disease, with two children with a fatal outcome in the neonatal period excluded. 25 children 1–17 years old with autosomal recessive polycystic kidney disease were divided into 2 groups depending on the presence of portal hypertension syndrome. In the long-term follow-up 10 (40%) of 25 children with autosomal recessive polycystic kidney disease had no signs of portal hypertension (group 1), 15 (60%) children had portal hypertension syndrome (group 2). The long-term follow-up, clinical, genealogical, laboratory and instrumental (US, MRI/CT of kidney and abdominal cavity, liver elastography) research methods were used in the study. The diagnosis was confirmed by autopsy for 3 children.Results. There were no cases of changes in the liver and bile ducts characteristic of autosomal recessive polycystic kidney disease by prenatal ultrasound examination. From 27 children with autosomal recessive polycystic kidney disease, in 10 (37%) were diagnosed the liver fibrosis in the long-term follow-up, 22 (81%) had cystic enlargement of intrahepatic veins, of which 15 (68%) had polycystic liver disease, 3 (14%) had Caroli disease. All children with autosomal recessive polycystic kidney disease and portal hypertension syndrome had varicose veins of the esophagus and stomach according to esophagoduodenoscopy, 53% with indications for ligation of phlebectasia, 47% were diagnosed with thrombocytopenia, 67% with anemia, 100% with splenomegaly, 13% with esophageal-gastric bleeding.Conclusion. The differences in the initial manifestations of autosomal recessive polycystic kidney disease were revealed, while no differences in the incidence of hepatic fibrosis and liver cysts were found in 2 compared groups of children.

Correlation of Liver Elastography as a Predictor of Esophageal Varices and Its Comparison With Ultrasound Abdomen and Liver Function Tests in Patients With Chronic Liver Disease.

Variceal haemorrhage is a life-threatening complication that occurs in up to 40% of patients with chronic liver disease including cirrhosis. It is associated with a mortality rate of 20%with each episode of variceal bleeding. Esophagogastroduodenoscopy is the gold standard for the detection of esophageal varices but is an invasive procedure and not verycost-effective. Our study was designed to correlate the presence of esophageal varices on endoscopywith the liver stiffness measurement using liver elastography inpatients with chronic liver disease. We also comparedvarious non-invasive predictors like laboratory parameters and ultrasound features andcorrelated them with the presence of varices inpatients with chronic liver disease. This prospective observational study was conducted ina tertiary-care hospital in South Indiafrom November 2017 to April 2019.All patients withchronic liver disease were subjected to endoscopy, and the presence ofesophageal varicesand their grading was noted. The predictive efficacy of ultrasound elastographyusing Toshiba Aplio 500 ultrasound two-dimensional shear wave elastography (2D-SWE) in predicting esophageal varices was calculated and compared with the efficacy of predictingesophageal varices by other non-invasive parameters like laboratory investigations, abdominal ultrasound, and liver scores like Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease (MELD) score, fibrosis 4 (FIB-4) score,aspartate aminotransferase-to-platelet ratio index (APRI) score, andaspartate aminotransferase/alanine aminotransferase ratio (AAR). The study includeda total of 168 patients out ofwhich 57% (96 patients) had no varices. About 52 patients(72.2%) had F1/Grade I varices,9(12.5%) had F2/Grade II varices, and 11 (15.3%) had F3/Grade III varices. The greatest predictive value for esophageal variceswas liver stiffness with a diagnostic accuracy of 81.7%.Ultrasound features likecoarse echotexture of the liver (66.7%), splenomegaly (67%), dilated portal vein (78.6%), and presence of moderate ascites (66.7%) had asignificantstatistical association with the presence of esophageal varices. Laboratory parameters like thrombocytopeniaof less than 1.5 lakhs/cu.mm (52.8%), albumin <3 g/dL (60.4%), and reversal of albumin/globulin ratio(52.4%) weresignificant predictors of esophageal varices. The odds ratio for significant scores in predicting oesophageal varices using binary logistic regression was significant in patients whose liver elastography grade wasmore than F4, CTP score was B, MELD score was >11, and FIB-4 scoreswas >3.25 and between 1.46 and 3.25. Liver elastography is a non-invasiveprocedure that can be a useful tool in predicting esophageal varices in chronic liver disease. Other non-invasive predictorslike ultrasound abdomen and laboratory parameters canalso be considered a replacement for repeatedinvasive endoscopy, thusfacilitating early intervention and avoiding unfavourable outcomes in patients withchronic liver disease.

103: Use of ultrasound liver elastography to monitor IFALD in SBS patients: experience from an Intestinal Rehabilitation Unit

103: Use of ultrasound liver elastography to monitor IFALD in SBS patients: experience from an Intestinal Rehabilitation Unit