Liver Stiffness is Reduced to Normal After Successful Renal Transplantation: A Prospective Cohort Study

Dharmendra S Bhadauria; Pankaj Kumar; Prachi Tiwari; Anupma Kaul; Tajwar S Negi; Praveer Rai; Sabrinath Shanmugam; Vamsidhar Veeranki; Narayan Prasad; Amit Goel

doi:10.1016/j.jceh.2022.06.002

Liver Stiffness is Reduced to Normal After Successful Renal Transplantation: A Prospective Cohort Study

J Clin Exp Hepatol. 2022 Nov-Dec;12(6):1445-1450. doi: 10.1016/j.jceh.2022.06.002. Epub 2022 Jun 9.

Affiliations

¹ Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
² Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Abstract

Background: Liver stiffness (LS) may be falsely elevated in patients on maintenance hemodialysis (MHD) due to fluid overload. We measured LS change by transient elastography (TE) in MHD patients before and after successful renal transplantation.

Method: Adults on ≥2 years of MHD, without additional risk factors for liver fibrosis or fluid overload, and planned for renal transplantation were prospectively recruited. LS was measured on two occasions, i.e., within two weeks before transplantation (pre-Tx LS) and after ≥ 3 months after successful transplantation (post-Tx LS). The participants with pre-Tx LS ≤ 7.0 KPa and >7.0 KPa were classified as "Group I" and "Group II," respectively. Categorical and numerical data are expressed as ratio/proportions and mean (SD), respectively.

Results: Paired data from 43 participants (males 42 [97.7%]; age 32 [11] years) were analyzed. The pre-Tx and post-Tx LS of the entire cohort, measured at 307 (198) days of interval, were 8.5 (7.3) KPa and 6.7 (3.1) KPa, respectively. Before transplantation, 21 (49%) participants belonged to Group II and 22 (51%) to Group I. Among the Group II participants, 12 (57%) showed LS normalization after 312 (182) days of transplantation. Of the 22 participants in Group I, three (13.6%) showed LS elevation to >7.0 KPa after 303 (217) days of transplantation. The mean LS changes among the overall cohort, Group II, and Group I were -1.8 KPa, -4.1 KPa, and +0.2 KPa, respectively.

Conclusion: LS in people on MHD may be falsely elevated, which is likely to normalize after successful renal transplantation.

Keywords: ALT, Alanine aminotransferase; AST, Aspartate aminotransferase; CKD, Chronic kidney disease; HCV, Hepatitis C virus; LS, Liver stiffness; MHD, Maintenance hemodialysis; TE, Transient elastography; chronic kidney disease; end-stage renal disease; fibroscan; hemodialysis; liver fibrosis; liver stiffness measurement; maintenance hemodialysis; renal transplantation.