Ultrasound-based transient elastography for the detection of hepatic fibrosis in patients with recurrent hepatitis C virus after liver transplantation: A systematic review and meta-analysis

Corlan O. Adebajo, Jayant A. Talwalkar, John J. Poterucha, W. Ray Kim, Michael R. Charlton

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Ultrasound-based transient elastography (TE) is a promising noninvasive alternative to liver biopsy for the detection of hepatic fibrosis due to recurrent hepatitis C virus (HCV) after liver transplantation (LT). However, its overall test performance in various settings remains unknown. The aim of this study was to perform a systematic review and diagnostic accuracy meta-analysis of studies comparing ultrasound-based TE to liver biopsy for the detection of hepatic fibrosis due to a recurrent HCV infection after LT. Electronic and manual bibliographic searches (including scientific abstracts) were performed to identify potential studies. A meta-analysis was conducted to generate pooled estimates of the sensitivity values, specificity values, likelihood ratios, and diagnostic odds ratios of individual studies. The extent of the heterogeneity and the reasons for it were assessed. Six fully published studies were identified for analysis. Five studies that evaluated significant fibrosis were identified. Among these studies, the pooled estimates were 83% for sensitivity [95% confidence interval (CI) = 77%-88%], 83% for specificity (95% CI = 77%-88%), 4.95 for the positive likelihood ratio (95% CI = 3.4-7.2), 0.17 for the negative likelihood ratio (95% CI = 0.09-0.35), and 30.5 for the diagnostic odds ratio (95% CI = 12.8-72.4). For the 5 studies that assessed cirrhosis, the pooled estimates were 98% for sensitivity (95% CI = 90%-100%), 84% for specificity (95% CI = 80%-88%), 7 for the positive likelihood ratio (95% CI = 2.8-17.3), 0.06 for the negative likelihood ratio (95% CI = 0.02-0.19), and 130 for the diagnostic odds ratio (95% CI = 36.5-462.1). A diagnostic threshold (or cutoff value) bias was identified as an important cause of heterogeneity for the pooled results of both patient groups. In conclusion, ultrasound-based TE has excellent diagnostic accuracy for identifying cirrhosis due to a recurrent HCV infection after LT. The detection of significant fibrosis is more accurate for these patients versus patients whose native liver is chronically infected with HCV. Liver Transpl 18:323-331, 2012.

Original languageEnglish (US)
Pages (from-to)323-331
Number of pages9
JournalLiver Transplantation
Volume18
Issue number3
DOIs
StatePublished - Mar 2012

Fingerprint

Elasticity Imaging Techniques
Hepacivirus
Liver Transplantation
Meta-Analysis
Fibrosis
Confidence Intervals
Liver
Odds Ratio
Virus Diseases
Biopsy

ASJC Scopus subject areas

  • Surgery
  • Transplantation
  • Hepatology

Cite this

Ultrasound-based transient elastography for the detection of hepatic fibrosis in patients with recurrent hepatitis C virus after liver transplantation : A systematic review and meta-analysis. / Adebajo, Corlan O.; Talwalkar, Jayant A.; Poterucha, John J.; Kim, W. Ray; Charlton, Michael R.

In: Liver Transplantation, Vol. 18, No. 3, 03.2012, p. 323-331.

Research output: Contribution to journalArticle

Adebajo, Corlan O. ; Talwalkar, Jayant A. ; Poterucha, John J. ; Kim, W. Ray ; Charlton, Michael R. / Ultrasound-based transient elastography for the detection of hepatic fibrosis in patients with recurrent hepatitis C virus after liver transplantation : A systematic review and meta-analysis. In: Liver Transplantation. 2012 ; Vol. 18, No. 3. pp. 323-331.
@article{8528bbade3ad4b26a092bbc3b444685f,
title = "Ultrasound-based transient elastography for the detection of hepatic fibrosis in patients with recurrent hepatitis C virus after liver transplantation: A systematic review and meta-analysis",
abstract = "Ultrasound-based transient elastography (TE) is a promising noninvasive alternative to liver biopsy for the detection of hepatic fibrosis due to recurrent hepatitis C virus (HCV) after liver transplantation (LT). However, its overall test performance in various settings remains unknown. The aim of this study was to perform a systematic review and diagnostic accuracy meta-analysis of studies comparing ultrasound-based TE to liver biopsy for the detection of hepatic fibrosis due to a recurrent HCV infection after LT. Electronic and manual bibliographic searches (including scientific abstracts) were performed to identify potential studies. A meta-analysis was conducted to generate pooled estimates of the sensitivity values, specificity values, likelihood ratios, and diagnostic odds ratios of individual studies. The extent of the heterogeneity and the reasons for it were assessed. Six fully published studies were identified for analysis. Five studies that evaluated significant fibrosis were identified. Among these studies, the pooled estimates were 83{\%} for sensitivity [95{\%} confidence interval (CI) = 77{\%}-88{\%}], 83{\%} for specificity (95{\%} CI = 77{\%}-88{\%}), 4.95 for the positive likelihood ratio (95{\%} CI = 3.4-7.2), 0.17 for the negative likelihood ratio (95{\%} CI = 0.09-0.35), and 30.5 for the diagnostic odds ratio (95{\%} CI = 12.8-72.4). For the 5 studies that assessed cirrhosis, the pooled estimates were 98{\%} for sensitivity (95{\%} CI = 90{\%}-100{\%}), 84{\%} for specificity (95{\%} CI = 80{\%}-88{\%}), 7 for the positive likelihood ratio (95{\%} CI = 2.8-17.3), 0.06 for the negative likelihood ratio (95{\%} CI = 0.02-0.19), and 130 for the diagnostic odds ratio (95{\%} CI = 36.5-462.1). A diagnostic threshold (or cutoff value) bias was identified as an important cause of heterogeneity for the pooled results of both patient groups. In conclusion, ultrasound-based TE has excellent diagnostic accuracy for identifying cirrhosis due to a recurrent HCV infection after LT. The detection of significant fibrosis is more accurate for these patients versus patients whose native liver is chronically infected with HCV. Liver Transpl 18:323-331, 2012.",
author = "Adebajo, {Corlan O.} and Talwalkar, {Jayant A.} and Poterucha, {John J.} and Kim, {W. Ray} and Charlton, {Michael R.}",
year = "2012",
month = "3",
doi = "10.1002/lt.22460",
language = "English (US)",
volume = "18",
pages = "323--331",
journal = "Liver Transplantation",
issn = "1527-6465",
publisher = "John Wiley and Sons Ltd",
number = "3",

}

TY - JOUR

T1 - Ultrasound-based transient elastography for the detection of hepatic fibrosis in patients with recurrent hepatitis C virus after liver transplantation

T2 - A systematic review and meta-analysis

AU - Adebajo, Corlan O.

AU - Talwalkar, Jayant A.

AU - Poterucha, John J.

AU - Kim, W. Ray

AU - Charlton, Michael R.

PY - 2012/3

Y1 - 2012/3

N2 - Ultrasound-based transient elastography (TE) is a promising noninvasive alternative to liver biopsy for the detection of hepatic fibrosis due to recurrent hepatitis C virus (HCV) after liver transplantation (LT). However, its overall test performance in various settings remains unknown. The aim of this study was to perform a systematic review and diagnostic accuracy meta-analysis of studies comparing ultrasound-based TE to liver biopsy for the detection of hepatic fibrosis due to a recurrent HCV infection after LT. Electronic and manual bibliographic searches (including scientific abstracts) were performed to identify potential studies. A meta-analysis was conducted to generate pooled estimates of the sensitivity values, specificity values, likelihood ratios, and diagnostic odds ratios of individual studies. The extent of the heterogeneity and the reasons for it were assessed. Six fully published studies were identified for analysis. Five studies that evaluated significant fibrosis were identified. Among these studies, the pooled estimates were 83% for sensitivity [95% confidence interval (CI) = 77%-88%], 83% for specificity (95% CI = 77%-88%), 4.95 for the positive likelihood ratio (95% CI = 3.4-7.2), 0.17 for the negative likelihood ratio (95% CI = 0.09-0.35), and 30.5 for the diagnostic odds ratio (95% CI = 12.8-72.4). For the 5 studies that assessed cirrhosis, the pooled estimates were 98% for sensitivity (95% CI = 90%-100%), 84% for specificity (95% CI = 80%-88%), 7 for the positive likelihood ratio (95% CI = 2.8-17.3), 0.06 for the negative likelihood ratio (95% CI = 0.02-0.19), and 130 for the diagnostic odds ratio (95% CI = 36.5-462.1). A diagnostic threshold (or cutoff value) bias was identified as an important cause of heterogeneity for the pooled results of both patient groups. In conclusion, ultrasound-based TE has excellent diagnostic accuracy for identifying cirrhosis due to a recurrent HCV infection after LT. The detection of significant fibrosis is more accurate for these patients versus patients whose native liver is chronically infected with HCV. Liver Transpl 18:323-331, 2012.

AB - Ultrasound-based transient elastography (TE) is a promising noninvasive alternative to liver biopsy for the detection of hepatic fibrosis due to recurrent hepatitis C virus (HCV) after liver transplantation (LT). However, its overall test performance in various settings remains unknown. The aim of this study was to perform a systematic review and diagnostic accuracy meta-analysis of studies comparing ultrasound-based TE to liver biopsy for the detection of hepatic fibrosis due to a recurrent HCV infection after LT. Electronic and manual bibliographic searches (including scientific abstracts) were performed to identify potential studies. A meta-analysis was conducted to generate pooled estimates of the sensitivity values, specificity values, likelihood ratios, and diagnostic odds ratios of individual studies. The extent of the heterogeneity and the reasons for it were assessed. Six fully published studies were identified for analysis. Five studies that evaluated significant fibrosis were identified. Among these studies, the pooled estimates were 83% for sensitivity [95% confidence interval (CI) = 77%-88%], 83% for specificity (95% CI = 77%-88%), 4.95 for the positive likelihood ratio (95% CI = 3.4-7.2), 0.17 for the negative likelihood ratio (95% CI = 0.09-0.35), and 30.5 for the diagnostic odds ratio (95% CI = 12.8-72.4). For the 5 studies that assessed cirrhosis, the pooled estimates were 98% for sensitivity (95% CI = 90%-100%), 84% for specificity (95% CI = 80%-88%), 7 for the positive likelihood ratio (95% CI = 2.8-17.3), 0.06 for the negative likelihood ratio (95% CI = 0.02-0.19), and 130 for the diagnostic odds ratio (95% CI = 36.5-462.1). A diagnostic threshold (or cutoff value) bias was identified as an important cause of heterogeneity for the pooled results of both patient groups. In conclusion, ultrasound-based TE has excellent diagnostic accuracy for identifying cirrhosis due to a recurrent HCV infection after LT. The detection of significant fibrosis is more accurate for these patients versus patients whose native liver is chronically infected with HCV. Liver Transpl 18:323-331, 2012.

UR - http://www.scopus.com/inward/record.url?scp=84857520241&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84857520241&partnerID=8YFLogxK

U2 - 10.1002/lt.22460

DO - 10.1002/lt.22460

M3 - Article

C2 - 22140010

AN - SCOPUS:84857520241

VL - 18

SP - 323

EP - 331

JO - Liver Transplantation

JF - Liver Transplantation

SN - 1527-6465

IS - 3

ER -