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- Title
Can aminotransferase-to-platelet ratio index and other non-invasive markers effectively reduce liver biopsies for renal transplant evaluation of hepatitis C virus-positive patients?
- Authors
Jiang, Yan; Huang, Edmund; Mehrnia, Alireza; Kamgar, Mandana; Pham, Phuong T.; Ogunorunyinka, Olaoluwapo; Brown, Isaiah; Danovitch, Gabriel M.; Bunnapradist, Suphamai
- Abstract
…after kidney TP, the use of antiviral regimens should again be possible in a relatively near future. Antiviral regimens will be without interferon and probably without ribavirin. Such regimens are already used with success after liver TP in the context of clinical trials…Background Advanced fibrosis or cirrhosis is still regarded as a contraindication for kidney transplantation alone by most centers. The value of aminotransferase to platelet ratio index (APRI) and other non-invasive markers has been less studied in hepatitis C virus (HCV)-positive patients with concurrent end-stage renal disease to predict hepatic fibrosis. Can these be used to effectively decrease the number of biopsies done in these patients being evaluated for transplantation? Methods Our study population included 255 patients with liver biopsy data. All patient information was collected and reviewed from medical records. The diagnostic accuracy of the predictive models was analyzed by calculating sensitivity, specificity, positive predictive value and negative predictive value. Results The variables associated with F3–F4 were aspartate aminotransferase (P = 0.007), bilirubin (P ≤ 0.001), platelet count (P = 0.01) and APRI (P ≤ 0.001). The use of any one laboratory abnormality to predict liver biopsy scores did not show high positive predictive values (22.6–72.7%). Having abnormal liver findings or cirrhosis on imaging was associated with high specificities (92.0–97.8%) but low sensitivities (31.4–42.9%). Using APRI levels of ≥0.40 and ≤0.95 as an indication for liver biopsy, 50% of patients with F3–F4 would have correctly avoided having a biopsy. However, 33% of patients with F3–F4 would have been mislabeled and not be indicated for biopsy. Conclusions Our data suggest that there may not currently be a simple and sufficiently accurate non-invasive test to replace liver biopsy in renal transplant workup for HCV-positive patients. The risks outweigh the benefits when it comes to using non-invasive markers like the APRI.
- Subjects
AMINOTRANSFERASES; GENETIC markers; LIVER biopsy; HEPATITIS C; KIDNEY transplantation; HEPATITIS C virus; PATIENTS
- Publication
Nephrology Dialysis Transplantation, 2014, Vol 29, Issue 6, p1247
- ISSN
0931-0509
- Publication type
Article
- DOI
10.1093/ndt/gft485