The Clinical Value Of Assessing Liver Allograft Fibrosis Post-Liver Transplantation Using APRI And FIB-4

Aim:The advent of liver fibrosis after liver transplantation(LT)usually predicted a poor long-term survival outcome.Non-invasive liver fibrosis testing methods allow continuous assessment and monitoring of liver fibrosis after LT.This study aimed to determine the usefulness of APRI and FIB-4 for the evaluation of liver fibrosis in LT recipients compared with transient elastography(TE).It also examined the risk factors associated with the development of advanced liver fibrosis following LT.Methods:This is a single-center and prospective study.Clinical data of LT recipients who were regularly followed up at the Organ Transplantation Center of Affiliated Hospital of Qingdao University from March 2021 to April 2022 were collected.All patients received TE to diagnose the degree of liver fibrosis by liver stiffness measurement(LSM).The following clinical data were collected:basic patient information,history of hypertension and diabetes mellitus,immunosuppressive agents’ application within 1 month,and laboratory test results(blood count,liver function,lipid level,etc.).The LT recipients were divided into two groups according to their degree of liver fibrosis,namely,non-advanced liver fibrosis group(F0-F2)and advanced liver fibrosis group(>=F3).APRI and FIB-4 results were calculated,and the diagnostic efficacy of APRI and FIB-4 in liver fibrosis were determined using the receiver operating characteristics(ROC)curve analyses.The risk factors for developing of advanced liver fibrosis were also assessed by logistic regression analyses.Results:①A total of 119 LT recipients was included in this study.According to the LSM measured by TE,78(65.5%)of 119 LT recipients had F0-F1 fibrosis,20(16.8%)had F2,15(12.6%)had F3,and 6 patients(5.0%)had F4 fibrosis.②There was a significant overall increase in APRI and FIB-4 with progression of liver fibrosis staging(both P<0.001).An APRI cutoff value of 0.4 detected advanced liver fibrosis(>=F3)after LT with an AUROC of 0.87(P<0.001).A FIB-4 cutoff value of 1.5 detected advanced liver fibrosis(>=F3)after LT with an AUROC of 0.80(P<0.001).Sensitivity and specificity of APRI were,respectively,86%and 82%,and those of FIB-4 were 100%and 53%.③Albumin level(P=0.009),GGT level(P=0.022),total cholesterol level(P=0.016)and platelet level(P=0.019)were independent risk factors of advanced liver fibrosis in LT recipients.Conclusions:Attention should be paid to the prevalence of liver fibrosis after LT.Graft fibrosis must be routinely screened for and monitored for.APRI and FIB-4 performed well in assessing the risk of combined advanced liver fibrosis in LT recipients and could be repeated.Postoperative GGT,albumin,total cholesterol,and platelet levels are independent risk factors for the development of advanced liver fibrosis in LT recipients,and early intervention may help to reduce the incidence of advanced liver fibrosis after LT and improve the prognosis.