Faculty Collaboration Database

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? Nephrol Dial Transplant 2014 Jun;29(6):1247-52

Date

12/20/2013

Pubmed ID

24353319

DOI

10.1093/ndt/gft485

Scopus ID

2-s2.0-84901745221 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

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.

Author List

Jiang Y, Huang E, Mehrnia A, Kamgar M, Pham PT, Ogunorunyinka O, Brown I, Danovitch GM, Bunnapradist S

Author

Mandana Kamgar MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aspartate Aminotransferases
Bilirubin
Biopsy
Contraindications
Female
Hepacivirus
Hepatitis C
Humans
Kidney Failure, Chronic
Kidney Transplantation
Liver Cirrhosis
Male
Middle Aged
Platelet Count
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index