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Canadian Journal of Gastroenterology and Hepatology
Volume 2017 (2017), Article ID 4381864, 8 pages
https://doi.org/10.1155/2017/4381864
Research Article

Incidence and Predictors of Advanced Liver Fibrosis by a Validated Serum Biomarker in Liver Transplant Recipients

1Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
2Division of Gastroenterology and Hepatology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
3Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada

Correspondence should be addressed to Mamatha Bhat

Received 22 April 2015; Accepted 13 June 2015; Published 19 March 2017

Academic Editor: Eric M. Yoshida

Copyright © 2017 Mamatha Bhat et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Aims. Serum fibrosis biomarkers have shown good accuracy in the liver transplant (LT) population. We employed a simple serum biomarker to elucidate incidence and predictors of advanced fibrosis after LT over a long follow-up period. Methods. We included 440 consecutive patients who underwent LT between 1991 and 2013. Advanced liver fibrosis was defined as FIB-4 > 3.25 beyond 12 months after LT. Results. Over 2030.5 person-years (PY) of follow-up, 189 (43%) developed FIB-4 > 3.25, accounting for an incidence of 9.3/100 PY (95% confidence interval [CI], 8.1–10.7). Advanced fibrosis was predicted by chronic HCV infection (adjusted hazard ratio (aHR) = 3.96, 95% CI 2.92–5.36, < 0.001), hypoalbuminemia (aHR = 2.31, 95% CI 1.72–3.09; < 0.001), and hyponatremia (aHR = 1.48, 95% CI 1.09–2.01; = 0.01). LT recipients with more than 1 predictor had a higher incidence of advanced fibrosis, the highest being when all 3 predictors coexisted (log-rank: < 0.001). Conclusions. Chronic HCV infection, hypoalbuminemia, and hyponatremia predict progression to advanced liver fibrosis following LT. Patients with these risk factors should be serially monitored using noninvasive fibrosis biomarkers and prioritized for interventions.