AASLD Voice of China| Dr. Xianbo Wang's Team: Multiple Studies in the Field of Primary Biliary Cholangitis Presented at AASLD Meeting

Editor’s Note: The Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) was held in Boston, USA, from November 10 to 14, 2023. Dr. Xianbo Wang’s team from Beijing Ditan Hospital, Capital Medical University, focused on several studies in the field of primary biliary cholangitis (PBC), which were prominently featured at the conference [1-3]. The team participated in the conference discussions through poster presentations, and we extend our congratulations! Hepatology Digest invited the team to provide a detailed introduction to the progress of their research for readers to learn and reference.

Research One

Correlation between ABO Blood Type and Histologic Fibrosis Stage in Patients with Primary Biliary Cholangitis

Abstract 4533-C: Association between ABO blood type and histologic fibrosis stage in patients with primary biliary cholangitis

Authors:

– First Author: Jialiang Chen

– Corresponding Author: Xianbo Wang

Research Background:

Primary Biliary Cholangitis (PBC) is an autoimmune-mediated chronic cholestatic liver disease that can progress to liver fibrosis and cirrhosis. Previous studies have shown that histological staging of liver tissue is an independent predictor of liver transplantation or death in PBC patients. Additionally, research has found a relationship between non-O blood types and increased risk of fibrosis in hepatitis C, but this conclusion has not been explored and validated in the PBC population. Therefore, this study aimed to investigate the correlation between blood type distribution and histologic staging in PBC patients.

Research Methods:

The study included 246 patients who met the diagnostic criteria for PBC and underwent both liver biopsy and ABO blood type testing. The Ludwig criteria were used to assess the histological staging of patients’ liver tissue. Multifactorial logistic regression analysis was employed to analyze the relationship between ABO blood type and histologic staging. Odds ratios (OR) and 95% confidence intervals (CI) for factors affecting histologic staging were calculated after multiple corrections.

Research Results:

The overall average age in this study was 51.2 ± 9.5 years, with 218 female cases (88.6%). The distribution of histological stages included 57 cases (23.2%) in stage I, 56 cases (22.7%) in stage II, 44 cases (17.9%) in stage III, and 89 cases (36.2%) in stage IV. The proportions of A, B, AB, and O blood types were 34.1%, 29.3%, 6.5%, and 30.1%, respectively. Non-O blood type (A, B, and AB) patients had a significantly higher risk of late-stage histology (III/IV) compared to O blood type (crude OR = 2.02, 95% CI: 1.16–3.51; fully adjusted OR = 4.48, 95% CI: 1.30–15.37). Furthermore, when anti-mitochondrial antibodies (AMA) or gp210 antibodies were negative, non-O blood type patients had a higher risk of late-stage histologic progression (crude OR = 4.52, 95% CI: 1.70–12.06; crude OR = 4.40, 95% CI: 1.54–12.57).

Research Conclusions:

This study is the first to explore the potential correlation between histologic staging of PBC and ABO blood type. The findings suggest that, compared to patients with blood type O, non-O blood type PBC patients have a higher risk of late-stage histologic progression. This implies that ABO blood type is an important influencing factor that should be considered in clinical decisions regarding fibrosis assessment in PBC.

Research Two

Assessment of Biopsy-Proven Liver Fibrosis by Transient Elastography (Fibroscan) in Patients with Primary Biliary Cholangitis: A Real-World Study in China

Abstract 4532-C: Assessment of biopsy-proven liver fibrosis by transient elastography (Fibroscan) in patients with primary biliary cholangitis: A Real-World Study in China

Authors:

– First Author: Jialiang Chen

– Corresponding Author: Xianbo Wang

Research Background:

Transient elastography (TE), based on Fibroscan, measures liver stiffness values (LSM) using non-invasive diagnostic technology and has been widely used to assess the degree of liver fibrosis in various chronic liver diseases, including non-alcoholic fatty liver disease, chronic hepatitis B, and PBC. However, existing studies on TE diagnosing liver fibrosis in PBC have primarily focused on Western populations, with limited research conducted on Asian or Chinese populations. Therefore, it is necessary to explore the diagnostic value of TE for liver fibrosis in Chinese PBC patients.

Research Methods:

The study included 277 confirmed PBC patients (88.4% female, median age 52 years), all of whom underwent liver biopsy and Fibroscan examination. Liver tissue staging and fibrosis staging were determined using the Ludwig staging criteria and the METAVIA scoring system, respectively. Spearman correlation tests were used to analyze the correlation between LSM and fibrosis staging. Receiver operating characteristic (ROC) curve analysis was employed to determine the accuracy of LSM in assessing histological and fibrosis staging. The best cutoff value for diagnosing fibrosis was determined and compared with reported serum liver fibrosis model scores, including APRI, FIB-4, AST/ALT ratio (AAR), GGT/PLT ratio (GPR), and Mayo Risk Score (MRS).

Research Results:

Under the METAVIA scoring system, the number of patients in fibrosis stages F0-F1, F2, F3, and F4 were 131 (47.3%), 40 (14.4%), 20 (7.2%), and 86 (31.0%), respectively. Under the Ludwig criteria, the number of patients in histological stages I, II, III, and IV were 89 (32.1%), 66 (23.8%), 36 (13.0%), and 86 (31.0%), respectively. LSM ranged from 2.8 to 75.0 kPa (median 10.1 kPa). LSM showed a significant positive correlation with fibrosis staging (Spearman correlation coefficient r=0.753, P<0.001) and histological staging (r=0.778, P<0.001). The ROC curve areas for LSM diagnosing fibrosis stages ≥F2, ≥F3, and F4 were 0.902 (95% CI: 0.860–0.934), 0.920 (95% CI: 0.881–0.949), and 0.904 (95% CI: 0.863–0.936), respectively. The cutoff values for LSM diagnosing fibrosis stages ≥F2, ≥F3, and F4 were 9.4 kPa, 14.9 kPa, and 16.1 kPa, respectively. LSM demonstrated significant superiority in evaluating significant liver fibrosis (≥F3) and late histological stages (III/IV) compared to serum liver fibrosis model scores such as FIB-4, APRI (P<0.05).

Research Conclusions:

In a real-world scenario, LSM measured based on TE demonstrates high accuracy in assessing fibrosis and histological staging in Chinese PBC patients. This reinforces the clinical decision-making strength of this technique as a preferred non-invasive assessment for PBC.

Research Three

The Presence of Hepatitis B Core Antibody Correlates with the Risk of Chronic Kidney Disease in Patients with Primary Biliary Cholangitis

Abstract 4583-C: The presence of hepatitis B core antibody correlates with the risk of chronic kidney disease in patients with primary biliary cholangitis

Authors:

– First Author: Jialiang Chen

– Corresponding Author: Xianbo Wang

Research Background:

Chronic kidney disease (CKD) is a common complication or comorbidity in patients with chronic liver diseases, particularly in those with chronic hepatitis B and decompensated cirrhosis. However, it is unknown whether the risk of CKD is higher in PBC patients with a history of HBV infection compared to those who have never been infected with HBV. This study aimed to explore the correlation between the risk of CKD occurrence in PBC patients with negative hepatitis B surface antigen (HBsAg) test results and the presence of hepatitis B core antibody (anti-HBc).

Research Methods:

A total of 1257 PBC patients were included, categorized into anti-HBc positive (n=503) and anti-HBc negative (n=754) groups based on the results of five hepatitis B tests. All patients tested negative for HBsAg. Demographic, clinical, and laboratory characteristics were collected, and the estimated glomerular filtration rate (eGFR) was calculated based on the CKD-EPI formula. CKD was defined as eGFR < 60 mL/min/1.73 m². Univariate and multivariate logistic regression analyses were used to determine the risk factors for CKD occurrence, and adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated.

Research Results:

In this study population, 1080 patients (85.9%) were female, with a median age of 57 years. The anti-HBc positive group had a higher median age (59 years vs. 56 years, P<0.001), higher median values of blood urea nitrogen (4.81 vs. 4.57 mmol/L, P=0.016) and serum creatinine (59.4 vs. 57.4 μmol/L, P=0.009), and a lower eGFR (101.1 vs. 103.0 mL/min/1.73 m², P=0.011) compared to the anti-HBc negative group. The overall prevalence of CKD in PBC patients was 8.3% (104/1257), with 232 cases (18.5%) showing mild kidney damage (eGFR < 90 but ≥ 60 mL/min/1.76 m²). The CKD prevalence in the anti-HBc positive group was significantly higher than that in the anti-HBc negative group (11.3% vs. 6.2%; OR=1.92, 95% CI: 1.28–2.88, P=0.002). In multivariate analysis, anti-HBc positivity (OR=1.56, 95% CI: 0.98–2.46, P=0.057), age (OR=1.12, 95% CI: 1.09–1.15, P<0.001), current smoking (OR=2.97, 95% CI: 1.30–6.79, P=0.010), hypertension (OR=1.85, 95% CI: 1.15–2.98, P=0.011), and decompensated cirrhosis (OR=3.71, 95% CI: 2.10–6.57, P<0.001) were independent factors associated with CKD occurrence.

Research Conclusions:

A history of past hepatitis B virus infection is closely associated with chronic kidney dysfunction in PBC patients, potentially increasing the risk of long-term adverse outcomes. Regular monitoring of renal function is recommended for PBC patients who are positive for anti-HBc in clinical practice.

References :

[1] Jialiang Chen, Yao Liu, Yufei Bi，et al. Association between ABO blood type and histologic fibrosis stage in patients with primary biliary cholangitis. Hepatology. 2023;78(Suppl. 1): S2036.

[2] Jialiang Chen, Yao Liu, Yufei Bi，et al. Assessment of biopsy-proven liver fibrosis by transient elastography (Fibroscan) in patients with primary biliary cholangitis: A Real-World Study in China. Hepatology. 2023;78(Suppl. 1): S2035.

[3] Jialiang Chen, Yao Liu, Yufei Bi，et al. The presence of hepatitis B core antibody correlates with risk of chronic kidney disease in patients with primary biliary cholangitis. Hepatology. 2023;78(Suppl. 1): S2083-S2084.