The Utilization of FibroScan in Pediatric Liver Transplant at a Single Tertiary Center

OBJECTIVES: Liver biopsy remains the gold standard to evaluate fibrosis. Vibration-controlled transient elastography (VCTE) utilizing FibroScan allows for non-invasive measurement of liver stiffness in liver transplant (LT) recipients. This study investigated the utilization of FibroScan in pediatric liver transplant recipients. METHODS: In a retrospective single-center analysis of children with LT who underwent at least one FibroScan, we investigated the correlation of biomarkers such as controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) from FibroScan with the severity of steatosis and fibrosis on liver biopsy. Advanced fibrosis (AF) was defined as bridging fibrosis and/or cirrhosis (fibrosis score 3-4) on liver biopsy. RESULTS: A total of 166 FibroScans from 74 children with LT (10 split and 64 whole liver) were included. Forty-seven children underwent liver biopsies. LSM was significantly correlated with AF (r = 0.63, p = 0.001). LSM greater than 7.9 kPa predicted AF with AUC 0.96% and 99% sensitivity, 84% specificity (p = 0.001). The 11 children with CAP ≥ 225 dB/m did not have any biopsy evidence of steatosis. Split liver recipients had significantly higher LSM than whole liver recipients (10.4 vs. 5.9 kPa, p = 0.05). CONCLUSIONS: VCTE is a practical tool to assess graft fibrosis in children with LT. Split livers have higher LSM measurement, which does not correlate with AF on biopsy. We speculate that VCTE can be useful for graft fibrosis surveillance in children with LT.