Noninvasive surrogates are poor predictors of liver fibrosis in patients with Fontan circulation

Yu Rim Shin, Seung Up Kim, Sak Lee, Jae Young Choi, Han Ki Park, Jeong Eun Yoo, Young Nyun Park

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Objectives: Patients with Fontan circulation exhibit a high incidence of liver fibrosis and cirrhosis. Transient elastography (TE) and the enhanced liver fibrosis (ELF) test have proven useful as noninvasive surrogate markers of liver fibrosis for other chronic liver diseases. We evaluated whether TE and the ELF score can predict the degree of liver fibrosis in patients with Fontan circulation. Methods: We retrospectively reviewed the medical records of 45 adult patients with at least 10 years of Fontan duration who had undergone liver biopsy and investigated the relation between the fibrosis stage and TE and the ELF test results. Additionally, the association of these variables and other biochemical and hemodynamic parameters was assessed. Results: The mean age was 25.9 years and the mean Fontan duration was 20.8 years. Advanced liver fibrosis was present in 36 (80.0%) patients. TE or ELF score are comparable for patients with and without advanced liver fibrosis (mean 23.3 vs 24.8 kPa [P = .85] for TE; mean 8.94 vs 9.25 [P = .44] for the ELF score). However, N-terminal pro-brain natriuretic peptide level and ventricular end-diastolic pressure were higher in patients with advanced liver fibrosis (mean 224 vs 80 pg/mL [P < .01]; and mean 12 vs 9 mm Hg [P = .04], respectively). No independent predictor of advanced liver fibrosis was found in multivariate analysis. Conclusions: TE and the ELF score were unable to predict the degree of liver fibrosis in Fontan patients. Liver biopsy remains as the only valid method to assess fibrotic burden in this population.

Original languageEnglish
Pages (from-to)1176-1185.e3
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number4
Publication statusPublished - 2022 Oct

Bibliographical note

Publisher Copyright:
© 2021 The American Association for Thoracic Surgery

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Noninvasive surrogates are poor predictors of liver fibrosis in patients with Fontan circulation'. Together they form a unique fingerprint.

Cite this