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Non-invasive assessment of liver fibrosis using magnetic resonance elastography in liver transplant recipients with hepatitis C


  • Conflict of interest: The authors have no financial disclosures or conflict of interests to note.

Corresponding author: Andrew Keaveny, MD, FRCPI, Department of Transplant, Mayo Clinic College of Medicine, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA.

Tel.: +904 956 3256; fax: +904 956 3359;




Liver biopsy has been the reference standard when evaluating fibrosis due to recurrent hepatitis after liver transplantation. Magnetic resonance elastography estimates liver stiffness, correlating to fibrosis.


To investigate the utility of elastography in staging liver fibrosis in transplant recipients with hepatitis C.


Fifty-four patients, ≥12 months post-transplant, underwent elastography within three months of biopsy. Discriminatory capability for METAVIR fibrosis stages F0–2 vs. F3–4 and receiver operating characteristic curve (ROC) analysis were determined.


On biopsy, 27 patients had METAVIR fibrosis score 0–1; 12 had a 3 or 4. There was significant correlation between histologic fibrosis and shear stiffness (R² = 0.588, p < 0.0001). Using a cutoff value of 3.5 kPa, elastography was 91% sensitive and 72% specific in differentiating fibrosis scores of ≥3 from 0 to 1. The AUC of elastography in predicting a fibrosis score of ≥3 was 0.92. Multivariate analysis revealed no correlation between the grade of histologic inflammation and liver stiffness measured by magnetic resonance elastography (R² = 0.265, p = 0.47).


Magnetic resonance elastography is an accurate non-invasive technique for excluding stage ≥3 graft in recipients with hepatitis C.