Researchers call for consistent biomarker scoring

More than 1500 persons in Norway have had a liver transplantation. But how can doctors know which patients need extra follow-up or additional treatment so that as many as possible can live a long life afterwards?

In some people, liver failure is caused by cancer, in others it is due to diseases where the immune system attacks the body's own tissue, while others have a liver seriously damaged by alcohol consumption.

Amongst those who have a liver transplantation, around 95 per cent are still alive one year later. After five years, 85 per cent are still alive. How can doctors receive signals at an early stage indicating which patients may need more treatment or following up more closely?

Researchers at the Institute of Basic Medical Sciences at the University of Oslo have looked at a large number of previously completed studies to find out how so-called biomarkers can help to foresee survival rates and complications.

Biomarkers are substances, molecules or even images that can be measured or detected in a body or cell and that can reveal information about an underlying condition. Typically, doctors can find these biomarkers in blood tests, urine samples or by using ultrasound.

Biomarkers can provide good answers about the health of the patient and the organ

In the article published in the scientific journal Liver Transplantation, the researchers analyzed studies covering many different biomarkers and combinations of these.

We investigated whether these gave signs as to how the patient would fare, both shortly after the operation and later on. The biomarkers were evaluated both in terms of whether they gave good explanations about the patient's health and as regards how the transplanted organ was functioning. Our findings can help doctors make treatments more effective in the future and to know which patients will need closer follow-up."

Andrea Camera, Section of Physiology, University of Oslo

Examples of biomarkers which can reveal something about patient survival after transplantation are the coagulation factors V and ALAT. But perhaps more importantly, the study compiled new combinations of biomarkers that have not previously been tested, explain the researchers.

Comparing biomarkers must be made easier

In the various studies the researchers looked at, different methods and medical scoring systems were used to measure how well the biomarkers worked. It was therefore not always easy for the researchers to compare the results.

"For this reason, we have drawn up recommendations as to how future studies could standardize this so that everyone uses the same scoring system. It is important to achieve a wide overview of which biomarkers function best in order to be able to foresee possible complications and get a picture of how the patient will fare", says Gustavo Jose Justo da Silva, postdoctoral fellow and one of the leaders of the study.

The researchers are now also checking the biomarkers against other conditions, such as heart diseases, diabetes and heart transplantations. The project leader for the studies is professor Kåre-Olav Stensløkken at the Institute of Basic Medical Sciences. The aim of the research is to increase the accessibility and function of donor organs for transplantation.