@Article{chd.12650,
AUTHOR = {Jessica L. Schachter, Manisha Patel, Samuel R. Horton, A. Mike Devane, Alex Ewing, Gary A. Abrams},
TITLE = {FibroSURE and elastography poorly predict the severity of liver fibrosis in Fontan-associated liver disease},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {5},
PAGES = {764--770},
URL = {http://www.techscience.com/schd/v13n5/39057},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> As the population of patients with Fontan circulation surviving into adult‐
hood increases, hepatic cirrhosis has grown to be a significant cause of morbidity and 
mortality. Early detection of advanced hepatic fibrosis is imperative for proper inter‐
vention and consideration for heart or combined heart/liver transplantation. 
Noninvasive biomarkers and elastography have been evaluated for their diagnostic 
utility with variable results in the Fontan population.<br/>
<b>Design:</b> The cohort included 14 patients age 26.4 SD 7.5 who underwent Fontan 
surgery. All patients were evaluated with FibroSURE, shear wave elastography (SWE), 
hepatic duplex sonography, and liver biopsy. Liver fibrosis on biopsy was evaluated 
according to the congestive hepatic fibrosis system. <br/>
<b>Results:</b> In our cohort, 100% of patients had fibrosis with 36% demonstrating ad‐
vanced fibrosis. FibroSURE agreed with liver biopsy in only 5 out of 14 cases (36%): 
underestimating in 7 and overestimating in 2 individuals. SWE agreed with liver bi‐
opsy in 0% of cases: overestimating in 10 and underestimating in 4 cases. None of the 
duplex sonography indices predicted the presence or severity of liver fibrosis. <br/>
<b>Conclusion:</b> This study demonstrates that children who have undergone a Fontan 
procedure universally develop some hepatic fibrosis and a significant number have 
advanced fibrosis by adulthood. The FibroSURE blood test, SWE, and hepatic duplex 
sonography were unable to accurately predict the presence or severity of hepatic 
fibrosis when compared with liver biopsy. Further studies are needed to investigate 
novel noninvasive methods and/or biomarkers that can adequately detect advanced 
hepatic fibrosis before the development of cirrhosis and hepatic decompensation.},
DOI = {10.1111/chd.12650}
}