A0459 - Diagnostic Accuracy of FibroScan Controlled Attenuation Parameter (CAP) as a Non-Invasive Test for Steatosis in Liver Transplant Recipients

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Jiten P. Kothadia, MD

James D. Eason Transplant Institute, Methodist University Hospital, University of Tennessee Health Science Center
Memphis, TN

Jiten P. Kothadia, MD¹, Tony M. Cheng, MD², Jordan Redfield, MD², Peter D. Snell, DO², Rahul Mohan, MD³, Thomas W. Faust, MD, MBE⁴, Satheesh P. Nair, MD, FACG⁴
¹James D. Eason Transplant Institute, Methodist University Hospital, University of Tennessee Health Science Center, Memphis, TN; ²University of Tennessee Health Science Center, Memphis, TN; ³University of Colorado, Aurora, CO; ⁴James D. Eason Transplant Institute, Methodist University, University of Tennessee Health Science Center, Memphis, TN

Introduction: Metabolic syndrome and obesity are common after liver transplantation (LT), leading to hepatic steatosis (HS). We evaluated the accuracy of the FibroScan controlled attenuation parameter (CAP) as a non-invasive test for the detection of steatosis in LT recipients.

Methods: This is a retrospective study comparing the accuracy of the FibroScan CAP to liver biopsy in detecting clinically significant steatosis (CSS) (Stage 2-3). The median time between liver biopsy and Fibroscan was 84 days [IQR: 14-317]. Experienced hepatopathologists did histological grading of the steatosis. The HS grades from liver biopsy were graded as S0 (< 5%), S1 (5–33%), S2 (33–66%), and S3 ( >66%). Areas under the receiver operator curves (AUROC), sensitivity, specificity, positive predictive value (PPV), and negative predictive (NPV) values were calculated (STATA16 Software). Optimal cut-off values maximizing specificity and sensitivity were determined.

Results: We evaluated 65 patients with a mean age of 57 years and a mean body mass index of 30 kg/m2. 26 (40%) had diabetes and hypertension of the total patients. After the liver transplant, the median time to liver biopsy was 15 months (IQR: 13-37). We found that 42 patients (64.6%) had no steatosis, 18 (27.7%) had S1, 4 (6.15%) had S2 and 1 (1.54%) had S3 steatosis. Overall, clinically significant steatosis (S2-S3) was present in 5 (7.7%) patients. The AUROC of the FibroScan, to detect CSS was 0.84 (Figure 1). For specific cut-off value FibroScan (CAP≥271), for detecting CSS has 100% sensitivity, 50% specificity of %, 14.30% PPV and 100% NPV. (Table 1A, 1B)

Discussion: FibroScan CAP is an excellent test to evaluate for CSS in LT recipients and minimize the need for liver biopsy to assess hepatic steatosis.

Figure: Figure 1: Accuracy of FibroScan in Predicting Clinically Significant Steatosis in Liver Transplant Recipient: Receiver Operating Characteristics (ROC) Analysis

Table 1A: Patient Characteristics

Parameter			Value (Total 65 patients)
Age (Years)			57 ± 11
Sex	Male		38 (58%)
	Female		27 (42%)
BMI			30 ± 5 *30 [27.2-33.6]
Race	Black		14 (21.6 %)
	White		48 (73.9%)
	Hispanic		1 (1.5%)
	Asian		1 (1.5%)
	Others		1 (1.5%)
Etiology	NASH		22 (33.9%)
	Alcohol		18 (27.7%)
	HCV		12 (18.5%)
	PSC		2 (3.1%)
	PBC		2 (3.1%)
	AIH		3 (4.6%)
	A1AT-Deficiency		1 (1.5%)
	Biliary Atresia		1 (1.5%)
	Hepatic Fibrosis		1 (1.5%)
	Cryptogenic		3 (4.6%)
Comorbidities	Diabetes		26 (40%)
	Hypertension		39 (60%)
	Hyperlipidemia		26 (40%)
	Coronary Artery Disease		11 (17%)
	H/O MI		4 (6%)
	Hypothyroidism		7 (11%)
	Chronic Kidney Disease		18 (28%)
Time between transplantation and Liver biopsy, Months			* 15 [13-37]
Liver Biopsy	Fibrosis Stage	F0	46 (70.8%)
		F1	20 (20.0%)
		F2	3 (4.6%)
		F3	1 (1.5%)
		F4	2 (3.1%)
	Inflammation	None	20 (30.8%)
		Mild	38 (58.4%)
		Moderate	7 (10.8%)
		Severe	0 (0%)
	Steatosis	None (S0)	42 (64.6%)
		Mild (S1)	18 (27.7%)
		Moderate (S2)	4 (6.2%)
		Severe (S3)	1 (1.5%)

Data presented as n/N (%) or count (%) for categorical variables and mean (standard deviation); *Median for continuous variables.

Abbreviations: NASH, Non-alcoholic steatohepatitis; HCV, Hepatitis C; PSC, Primary sclerosing cholangitis; PBC, Primary biliary cholangitis; A1AT, Alpha -1 anti-trypsin; CAD, Coronary artery disease; DM, diabetes; HTN, hypertension,

Table 1B: Sensitivity, Specificity of FibroScan for Detecting for Detecting Significant steatosis (S2-S3) Using Biopsy as a Gold Standard Test.

	Cut-Off value	Sensitivity	Specificity	PPV	NPV	LR+	LR-
CAP Score (dB/m)	≥ 271	100%	50%	14.30%	100%	2.00	0.00

Table: Table 1: (A) Patient characteristics. (B) Sensitivity, Specificity of FibroScan for Detecting for Detecting Significant steatosis (S2-S3) Using Biopsy as a Gold Standard Test.

Disclosures:

Jiten Kothadia indicated no relevant financial relationships.

Tony Cheng indicated no relevant financial relationships.

Jordan Redfield indicated no relevant financial relationships.

Peter Snell indicated no relevant financial relationships.

Rahul Mohan indicated no relevant financial relationships.

Thomas Faust indicated no relevant financial relationships.

Satheesh Nair indicated no relevant financial relationships.

Jiten P. Kothadia, MD¹, Tony M. Cheng, MD², Jordan Redfield, MD², Peter D. Snell, DO², Rahul Mohan, MD³, Thomas W. Faust, MD, MBE⁴, Satheesh P. Nair, MD, FACG⁴. A0459 - Diagnostic Accuracy of FibroScan Controlled Attenuation Parameter (CAP) as a Non-Invasive Test for Steatosis in Liver Transplant Recipients, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.