Liver transplantation is the treatment of choice for end-stage chronic disease due to the hepatitis C virus (HCV) and for selected patients with hepatocellular carcinoma who are not candidates for surgical resection (1).
the recurrence of HCV infection is the rule in viremic patients at the time of transplantation (2).
HCV relapse on the graft is the main cause of HCV infection in patients who undergo a liver transplant for cirrhosis due to HCV (3).
The most important events that influence the severity of HCV relapse occur during the first year after transplantation,
and it is essential to identify patients with significant inflammation,
fibrosis or portal hypertension,
as these are the issues that are more likely to decompensate or lead to graft loss (4).
These complications are associated with an increase in parenchymal rigidity.
Liver biopsy is considered the â€śgold standardâ€ť for fibrosis assessment and stage classification and can also grade necro- inflammatory activity.
liver biopsy is limited by the following issues: its invasiveness (with potential severe complications in up to 1%),
small size of the sample (the specimen represents roughly only 1/50000 of the liver volume),
and inter and intra-observer variability at microscopic evaluation
In the follow-up of liver transplant patients,
the diagnostic imaging test performed routinely is ultrasound (B-mode and Doppler) (5).
Acoustic radiation force impulse (ARFI) imaging (Siemens-ACUSON) is an ultrasound elastographic technique which is integrated in an ultrasound device,
based on the measurement of shear wave velocity (SWV) in a ROI (region of interest).
SWV is related to mechanic tissue properties; the higher the shear wave speed,
the higher the rigidity/stiffness of the tissue (6).
new direct-acting antiviral treatments have emerged which have changed the landscape of the treatment of patients with HCV (7),
since these are more effective and better tolerated drugs (2,8),
which achieve a maintained viral response in 90% of the cases (9).
The aim of this study is to evaluate the hepatic stiffness modification estimated by ARFI elastography after antiviral treatment in patients with liver transplantation and HCV infection with relapse in the post-transplant period.