MRI-serum-based score accurately identifies liver transplant patients without rejection avoiding need for liver biopsy: A multisite European study.

BACKGROUND

Serum liver tests (serum tests) and histological assessment for T-cell mediated (TcM) rejection are essential for post-liver transplant monitoring. Liver biopsy carries risk of complications which are preferably avoided in low-risk patients. Multiparametric MRI (mpMRI) is a reliable non-invasive diagnostic method which quantifies liver disease activity and has prognostic utility. Our aim was to determine whether using mpMRI in combination with serum tests could noninvasively identify low-risk post-liver transplant patients who are eligible to avoid invasive liver biopsies.

METHODS

In a multicentre prospective study (RADIcAL2), including 131 adult and paediatric (children and adolescent) patients with previous liver transplant from the Netherlands, Portugal, and UK, concomitant mpMRI and liver biopsies were performed. Biopsies were centrally read by two expert pathologists. TcM rejection was assessed using BANFF global assessment (BANFF-GA). Diagnostic accuracy to discriminate no rejection vs. indeterminate or TcM liver transplant rejection was performed using area under the receiver operating characteristic curve (AUC).

RESULTS

In this study, 52% of patients received a routine (protocol) biopsy whilst 48% had a biopsy for suspicion of pathology. 38% of patients had no rejection, while 62% had either indeterminate (21%) or TcM rejection (41%). However, there was a high inter-observer variability (0<Cohen's Kappa<0.85) across all histology scores. The combined score of mpMRI and serum tests had AUC 0.7 (NPV: 0.8) to identify those without either indeterminate or TcM rejection.

CONCLUSION

Combining both imaging and serum biomarkers into a composite biomarker (imaging and serum biomarkers) has potential in monitoring the liver graft to effectively risk stratify patients and identify those most likely to benefit from a non-invasive diagnostic approach, reducing the need for liver biopsy.

Informations de copyright

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.