Correlation of Fibro-scan with liver biopsy to assess Iron Overload in Beta Thalassemia Major patients undergoing bone marrow transplant

Objective: To compare the role of fibro-scan and liver biopsy in staging hepatic fibrosis secondary to iron overload. Study Design: Cross-Sectional study. Place and Duration: This study was carried out at The Armed Forces Bone Marrow Transplant Centre Rawalpindi, Pakistan, from 1st Dec, 2021 to 30th June, 2022. Methodology: All patients (both genders, 4-10 years of age) with beta thalassemia major undergoing allogenic bone marrow transplant were incorporated into the research. While patients aged ≤3 and ≥10 were excluded from the study and those with liver fibrosis grade >3/6 as per Ishak Score. To determine the extent of liver fibrosis, elastography and liver biopsy were performed on each patient. Results: This study included 24 beta thalassemia major including 62.5% males and mean age of 6.42± 2.73 years. As per Ishak fibrosis about 50% of the patients had evidential liver fibrosis (≥2/6). Using Fibro scan; liver fibrosis grade (F0) was encountered in 33.3% patients, (F1) in 25% patients and (F2) in 41.6% patients. The mean of elasticity as per METAVIR classification in F0 patients was 5.2±0.58 kiloPascal’s (kPa), in F1 was 6.6±0.25 kPa and in F2 was 7.3±0.17 kPa, which revealed a statistically significant difference in the degree of liver stiffness in different grades of liver fibrosis (p=0.0001). There was no significant association in the findings of fibro scan with liver biopsy (p=0.37) and no statistically significant correlation was found between liver biopsy findings with increasing liver elasticity (kpa) (p=0.11) measured by fibro scan. Conclusion: To conclude, liver fibro-scan cannot be used as surrogate for liver biopsy to assess fibrosis progression in thalassemia patients. Therefore, liver biopsy remains the gold standard for evaluating liver fibrosis and cannot be replaced by non-invasive fibro scan method. Keywords: Hematopoietic stem cell transplant, Beta thalassemia major, Allogeneic, Liver biopsy, Fibro-scan, Liver fibrosis. How to Cite This: Rahim U, Ali MZ, Iftikhar R, Khattak TA, Khan H, Afzal M, et al. Correlation of fibro-scan with liver biopsy to assess iron overload in beta Thalassemia major patients undergoing bone marrow transplant. Isra Med J. 2024; 16(2): 42-46. DOI: https://doi.org/10.55282/imj.oa1422