Dr Emer Fitzpatrick (Liver)

Dr Emer Fitzpatrick - 2015 BSPGHAN / Core Development Award
Dr Emer Fitzpatrick – 2015 Core / BSPGHAN Development Award

Institution: King’s College London

Title: LiverMultiScanTM for the assessment of graft fibrosis in children post-liver transplant

Project Start Date: 9 November 2015

Completion Date: 8 May 2017

Although liver transplantation in children is a lifesaving procedure, with more than 80% of patients surviving for at least 10 years after the transplant, a number of recent studies have highlighted problems with the transplanted liver after 5 and 10 years. Inflammation and scarring are present in the vast majority of transplanted livers. The major worry is that this injury will worsen and the organ will not work properly long-term. If changes are made, for example with the medicines that the patient is taking, worsening of this injury can be slowed and even reversed. In the majority of cases, there is no outward sign of liver problems and the blood tests and ultrasound may be completely normal, so a different test (liver biopsy) is generally needed to find this inflammation and scarring. Liver biopsy is an invasive test with risks attached and involves admission to hospital, sedation etc. We want to investigate the use of an MRI scan (which is quick, pain-free and does not involve any radiation) compared with liver biopsy to see if it is as good at finding any scarring and inflammation in the transplanted organ. We hope to ultimately replace ‘surveillance’ liver biopsy with a quick, ‘non-invasive’ MRI scan which could be done on a yearly basis. This way we want to develop a strategy to keep transplanted livers in the best condition possible for the long-term.

Dr Patrick McKiernan, Consultant Paediatric Hepatologist in Birmingham Children’s Hospital is co-investigator on this project and will be recruiting patients from Birmingham. Perspectum Diagnostics in Oxford is the company which has developed the novel MRI technique that we will be using and they will analyse the MRI data.

We will ask 20 children who are undergoing routine ‘surveillance’ liver biopsies at 5 and 10 years after transplant to undergo an MRI scan within 3 months of the liver biopsy. This will be done over a period of a year and the MRI will be done in either King’s College Hospital or Birmingham Children’s Hospital – wherever the patient attends. The MRI scan takes about 20 minutes and doesn’t involve any radiation. The MRI images will be analysed using a specific software package developed by Perspectum Diagnostics. We will then compare these results to the patient’s liver biopsy and assess if the MRI gives the same amount of information as the biopsy. As part of this a predictive score will be developed using statistical analysis. The project will be done over a year as a pilot study to check that it is feasible and that it gives useful results.

We expect that the result of the MRI scan will give us a good non-invasive picture of the scarring and inflammation in the patients liver biopsy. This study is designed to pilot the new technique and will give us the information we need to roll this out into a larger clinical trial. Eventually we hope to replace liver biopsy for ‘surveillance’ purposes for a reliable ‘non-invasive’ test. The results of this test will be used to guide management in terms of immune-suppression. The ultimate aim is to be able to preserve a transplanted organ in the best condition possible for the longest time possible.

The Joint Core-BSPGHAN award has enabled us to investigate a very promising new MRI based technique that measures inflammation, scarring and fat in the liver without the need for liver biopsy. Children and young people who have had a liver transplant often need quite frequent liver biopsies to tell us what is going on in the liver and understand what we have to do to keep the liver healthy. We hope that this new type of MRI will allow us to detect any problems in the transplanted liver without the risks and discomfort associated with liver biopsy.

Dr Emer Fitzpatrick