TBA (22W140)

APRI (Aspartate Aminotransferase to Platelet Index) performs better than Transient Elastography (Fibroscan®) in predicting significant fibrosis in patients post Fontan procedure

Author(s)

Dr Paul Armstrong, Dr Aoife Moriarty, Dr Niamh Mehigan Farrelly, Dr Jennifer Russell, Dr Eleanor Ryan, Prof Stephen Stewart

Department(s)/Institutions

Department of Hepatology, Liver Unit, Mater Hospital, Dublin 7.

Introduction

Fontan Associated Liver Disease (FALD) results from haemodynamic changes following the Fontan procedure for congenital heart disease, with many patients developing advanced fibrosis.

Aims/Background

Determine the prognostic value of FIB-4, APRI and liver stiffness (LS) scores in predicting histologically confirmed fibrosis in patients under investigation for FALD, to contribute important data regarding optimal non-invasive diagnostic methods for cirrhosis in FALD.

Method

Retrospective cohort study of patients with Fontan’s undergoing liver biopsy. Data collected included FIB-4 and APRI scores, liver stiffness and histological staging (METAVIR 0-4), analysed using SPSS.

Results

48 patients identified (22 females, 26 males). Median age 26 (range 21-34 years). Fontan performed a median of 17 years before biopsy (15-23). Median LS 23.1kPa (17.2-26.6). 2 patients had no fibrosis (F0), 17 patients had mild fibrosis (F1-F2), and 29 patients had significant fibrosis (F3-F4). The median age of patient diagnosed with significant fibrosis was 26. Median LS for patients with significant fibrosis on biopsy was 23.9 (SD13.1) vs 19.2 (SD 5.97) for those without. No statistical association was found between higher LS and presence of significant fibrosis on biopsy (p=0.115). Mann Whitney U Test revealed significant difference in APRI scores of those found to have significant fibrosis on biopsy versus those without (0.7+/- 0.43 vs 0.48 +/- 0.21, p= 0.045). Spearman correlation coefficient =0.33, p= 0.043.

Conclusions

This study demonstrates that APRI performs better than Fibroscan as a non-invasive predictive test to identify risk of significant fibrosis in FALD. Liver biopsy remains the only accurate investigation for diagnosing advanced fibrosis in FALD.