{
  "abstract": "Non-invasive assessment of liver fibrosis is increasingly important in paediatric liver transplant recipients, as ongoing graft fibrosis threatens long-term outcomes but biopsies remain invasive and associated with morbidity. 1 Serum indices such as APRI (AST to Platelet Ratio Index), Forns index, and FIB-4 (Fibrosis-4) have been widely studied in adults; however, recent studies suggest reduced diagnostic reliability in paediatric and post-transplant settings, with variable sensitivity and specificity. Despite advances in novel biomarkers and imaging modalities, data directly comparing these indices with histological findings in paediatric transplant cohorts remain limited.2 3 This study evaluted non-invasive serum fibrosis markers against histological findings in paediatric liver transplant recipientsThis retrospective study included 109 children who underwent protocol liver biopsies at 1 and 5 years post-transplant between 2017 and 2023. Patients were included if blood tests results were available within 24 hours of biopsy. Non-invasive fibrosis assessment included the APRI, Fib-4 index, and Forns index. Histopathology fibrosis was graded as nil, mild, moderate, or severe as reported by a specialist histopathologist.Ordinal proportional-odds regression models were used to assess associations between each score and fibrosis severity. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. Two ROC comparisons were performed: (1) any fibrosis (mild–severe) vs nil (ROC-1) and (2) clinically significant fibrosis (moderate + severe) vs nil + mild (ROC-2). For each score, the area under the ROC curve (AUC), optimal thresholds, and corresponding sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.In the proportional-odds models, none of the three indices demonstrated statistically significant associations with fibrosis severity (all p > 0.05). In ROC-1 analysis, discrimination was poor for all scores: AUC = 0.47 (95% CI 0.33–0.59) for APRI, 0.49 (0.36–0.62) for FIB-4, and 0.48 (0.35–0.60) for Forns. ROC-2 analysis showed modest improvement: AUC = 0.59 (0.46–0.71) for APRI, 0.59 (0.47–0.72) for FIB-4, and 0.63 (0.50–0.75) for Forns. At optimal thresholds (APRI = 0.44, FIB-4 = 0.24, Forns = –2.53), sensitivities/specificities were 0.59/0.63, 0.63/0.61, and 0.84/0.49, respectively. PPVs ranged from 0.35–0.37 and NPVs from 0.83–0.91.In differentiating moderate or severe fibrosis from nil or mild disease, Forns index showed the greatest diagnostic accuracy, followed by FIB-4 and APRI. Although none achieved strong discriminatory performance, all three demonstrated acceptable NPVs (>0.8) suggesting potential utility as screening tools to exclude advanced fibrosis. The absence of contemporaneous FibroScan (elastography) data limited direct comparison between serum markers and imaging-based assessment. Non-invasive markers alone remain insufficiently sensitive post-transplant, underscoring the need for protocol biopsies and further correlation with elastography and novel biomarkers.References Ozdogan E, Moore NA, Park WD et al. Liver fibrosis in children: a comprehensive review of pathogenesis, diagnosis and current treatment strategies. Pediatr Gastroenterol Hepatol Nutr 2022;25(1):1–14.Vo HD, Xenidis D, O’Riordan A et al. Diagnostic performance of non-invasive tests for evaluation of hepatic graft fibrosis in children. Clin Transplant 2020;34(11):e14017.Vo HD, Harp KA, Mauch TJ. Diagnostic performance of non-invasive tests for evaluation of hepatic graft fibrosis in pediatric liver transplantation: a scoping review. Transpl Rev (Orlando) 2020;34(4):100568. doi:10.1016/j.trre.2020.100568Abstract OC41 Table 1Diagnostic performance of non-invasive serum fibrosis markers versus histology in paediatric liver transplant recipientsScoreOdds ratio (per unit)95% CIROC-2 AUC (Mod/severe vs Nil/mild)95% CIOptimal thresholdSensitivitySpecifictyPPVNPVAPRI1.300.9 - 1.960.590.46 - 0.710.440.590.630.340.82Fib-41.930.83 - 11.830.590.47 - 0.720.240.630.610.350.83Forn’s1.070.92 - 1.220.630.50 - 0.75-2.530.840.490.350.91",
  "authors": [
    {
      "affiliations": [
        "Liver Unit (Including Small Bowel Transplantation), Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK"
      ],
      "name": "Siddharth Mahesh"
    },
    {
      "affiliations": [
        "Liver Unit (Including Small Bowel Transplantation), Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK"
      ],
      "name": "Aseel Hraishawi"
    },
    {
      "affiliations": [
        "Liver Unit (Including Small Bowel Transplantation), Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK"
      ],
      "name": "Chayarani Kelgeri"
    },
    {
      "affiliations": [
        "Liver Unit (Including Small Bowel Transplantation), Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK"
      ],
      "name": "Jane Hartley"
    },
    {
      "affiliations": [
        "Liver Unit (Including Small Bowel Transplantation), Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK"
      ],
      "name": "Lauren Johansen"
    },
    {
      "affiliations": [
        "Liver Unit (Including Small Bowel Transplantation), Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK"
      ],
      "name": "Joseph Valamparampil"
    },
    {
      "affiliations": [
        "Liver Unit (Including Small Bowel Transplantation), Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK"
      ],
      "name": "Jake Mann"
    },
    {
      "affiliations": [
        "Liver Unit (Including Small Bowel Transplantation), Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK"
      ],
      "name": "Girish Gupte"
    }
  ],
  "title": "OC41 Evaluating non-invasive serum fibrosis markers against histological findings in paediatric liver transplant recipients",
  "uid": "5a5f0748-8368-566f-b91f-4f6af5f0d441"
}