The aim of this study was to evaluate the changes in liver shear wave velocity values obtained by Acoustic Radiation Force Impulse (ARFI) elastography after antiviral treatment in patients with orthotopic liver transplants and hepatitis C virus (HCV) infection with relapse after transplantation.
The increased shear wave velocity in elastography,
as well as the analytical data,
is not specific for liver involvement due to viral recurrence,
but it offers additional information with a different foundation from that of the analytical one: a physical,
rather than functional foundation.
The justification of the use of elastography in the clinical management of these patients is to have additional quantitative information that can serve as an indicator of liver involvement.
In our sample,
the decrease in shear velocity was significant in all patients after treatment.
The determination of hepatic stiffness with ARFI technique is simple,
quick (performance takes about 5 minutes long) (11),
reproducible (12) and can be performed during the scheduled ultrasound control scans or during any ultrasound performed because of suspicion of a complication,
so it does not add cumbersome tests or more visits to the hospital.
Stiffness estimation by means of SWE can be considered as another parameter to evaluate the graft state and evolution,
which may help the clinician to support clinical suspicions and to make decisions and indicate other more complex or aggressive tests.
It can also alert of some complications that could be unnoticed,
as in the case of the patient with Budd Chiari in which the speeds were persistently elevated despite obtaining a good response to antiviral treatment.
Some studies have been published that suggest the usefulness of elastography in the follow-up of patients receiving liver transplantation,
in patients with HCV reinfection to detect patients with worse evolution in which to prioritize the start of antiviral treatment (4,13) or to assist in the decision to perform a liver biopsy (14).
This study is limited by having a small number of patients and not having a biopsy of all of them.
the earliness of the alterations,
their reversibility (both of the analytical values and the velocities in the elastography) and the results from the available biopsies,
suggest that SWE high values are due to inflammation rather than fibrosis.
this is an exploratory study in liver transplant recipients with viral recurrence in which,
despite having a small sample,
it has been shown that the value of the shear wave velocity decreases significantly after antiviral treatment.
This suggests that ARFI elastography can be a useful tool in the monitoring of the response to treatment with direct-acting antivirals in patients with HCV relapse on hepatic graft.