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<p>While liver biopsy is the gold standard for assessing liver fibrosis, the optimal scoring system for Fontan-associated liver disease (FALD) is debated. This study was to determine the correlation and agreement between the METAVIR score, used for chronic hepatitis, and the Congestive Hepatic Fibrosis Score (CHFS), specifically designed for congestive hepatopathy. We conducted a retrospective review of liver biopsies from 38 Fontan patients. Pathologists independently evaluated each biopsy and assigned a METAVIR fibrosis score and a CHFS. Fontan patients, a mean age of 21 ± 6 years, have undergone the Fontan operation at a mean age of 8 ± 4 years. This established a mean postoperative interval of 13 ± 4 years at the time of study enrollment. When comparing the two scoring systems, the overall weight Kappa of 0.92 suggested perfect agreement between the two methods for assessing the degree of liver fibrosis. However, a subgroup analysis of weight kappa agreement revealed significant differences based on fibrosis severity. In the low-grade fibrosis group, the agreement was substantial agreement (kappa 0.70). In sharp contrast, the high-grade liver fibrosis group (METAVIR F3-F4 and CHFS stages 3–4) demonstrated perfect agreement (kappa 0.90) between the two scoring systems. Overall, METAVIR and CHFS demonstrate strong correlation and agreement. Differences observed in early-stage fibrosis likely arise from their distinct architectural emphases; portal-based in METAVIR versus centrilobular in CHFS.</p> Graphical abstract <p></p>

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A Tale of METAVIR and Congestive Hepatic Fibrosis Score: Evaluating Liver Fibrosis Assessment in Fontan Patient

  • 期刊论文

  • 发表日期：

    2026年5月6日

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  • Saviga Sethasathien,
  • Rekwan Sittiwangkul,
  • Apinya Leerapun,
  • Sarawut Kongkarnka,
  • Nakarin Inmutto,
  • Suchaya Silvilairat

摘要

While liver biopsy is the gold standard for assessing liver fibrosis, the optimal scoring system for Fontan-associated liver disease (FALD) is debated. This study was to determine the correlation and agreement between the METAVIR score, used for chronic hepatitis, and the Congestive Hepatic Fibrosis Score (CHFS), specifically designed for congestive hepatopathy. We conducted a retrospective review of liver biopsies from 38 Fontan patients. Pathologists independently evaluated each biopsy and assigned a METAVIR fibrosis score and a CHFS. Fontan patients, a mean age of 21 ± 6 years, have undergone the Fontan operation at a mean age of 8 ± 4 years. This established a mean postoperative interval of 13 ± 4 years at the time of study enrollment. When comparing the two scoring systems, the overall weight Kappa of 0.92 suggested perfect agreement between the two methods for assessing the degree of liver fibrosis. However, a subgroup analysis of weight kappa agreement revealed significant differences based on fibrosis severity. In the low-grade fibrosis group, the agreement was substantial agreement (kappa 0.70). In sharp contrast, the high-grade liver fibrosis group (METAVIR F3-F4 and CHFS stages 3–4) demonstrated perfect agreement (kappa 0.90) between the two scoring systems. Overall, METAVIR and CHFS demonstrate strong correlation and agreement. Differences observed in early-stage fibrosis likely arise from their distinct architectural emphases; portal-based in METAVIR versus centrilobular in CHFS.

Graphical abstract