Journal Article

P83 Evaluation of transient elastography in monitoring of liver fibrosis in patients with autoimmune hepatitis (AIH)

Gleeson, Dermot, Yin, James Liu, Hoeroldt, Barbara, Lovering, Sophie

2022

Overview

IntroductionDe novo cirrhosis develops on treatment in 20-30% of patients with AIH and predicts adverse outcomes (Gleeson D. Clin Liver Dis. 2019;14:24). Its prevention may be helped by effective serial monitoring of fibrosis. Transient elastography (Fibroscan, FS) is a validated marker of fibrosis in other liver diseases and evidence in AIH suggests reasonable accuracy after 6 months of treatment. (Anastasiou OE. Hepat Mon. 2016;16(11), Hartl J. J Hepatol 2018;68(4):754).MethodsThis is a retrospective single-centre review of serial FS in patients with AIH to assess changes in fibrosis and their associations, who had >2 FSs since 1/1/2017. FS validity was by criteria of Boursier, including an IQ range/median ratio of <0.30 (Boursier J. Hepatology. 2013;57(3):1182). We gathered information on liver biopsies and on serum AST, ALT and IgG values (Before 1st FS, after last FS and between). Data were analysed using SPSS.Results52 patients (10 M, age (mean±SD) 62±15 years) had >2 FSs performed, which were valid in 50 patients. First FS was performed (mean±SD) 8±6 years after diagnosis, when in 44 patients, serum ALT (mean of values before and after scan) was < twice normal. Interval between scans was 2.2±0.9 (range 0.5-4) years.Median FS score fell slightly from FS1:7.7±3.6 to FS2: 7.2±3.1 KPa (p=0.001). FS score increased in 24%, decreased in 40% and was unchanged (<1kPa change) in 36%. 1st and 2nd FS scores were highly correlated (p=0.001). However in 3 patients, FS score increased from 5.0, 7.0 and 7.0 to 12.5, 15.0 and 16.0, and in 3 others fell from 14.0, 14.0 and 11.0 to 7.0, 4.0 and 4.0.FS1 score was correlated with Ishak fibrosis stage on initial liver biopsy (n=27,p=0.003). However, neither FS1 nor FS2 scores correlated with fibrosis on subsequent biopsies. There were no associations found in the difference between FS1 and F2 scores (Δ FS score) and median serum ALT, AST, IgG values between the scans. Nor did Δ FS score differ between (a) those with and without a relapse of AIH between the scans (b) those maintaining (vs not maintaining) complete biochemical remission between the scans. These associations were also absent, regarding FS2 score considered on its own, apart from an association with median serum IgG between the scans (p=0.003).ConclusionsThe overall fall in FS score with time is reassuring. However, the marked and arguably implausible changes in some patients are of concern. The absence of associations between Δ FS score and F2 scores and several parameters of inflammatory activity in contrast to results of Hartl et al are surprising, given established associations of fibrosis progression with ongoing inflammation. Further evaluation is needed of FS as a serial marker of fibrosis in AIH.

• Publisher: BMJ Publishing Group Ltd and British Society of Gastroenterology,BMJ Publishing Group LTD
• Subject: Biopsy / Cirrhosis / Fibrosis / Hepatitis / Immunoglobulin G / Inflammation / Liver / Liver cirrhosis / Liver diseases / Patients / Poster presentations / Remission