*Purpose: Hepatic fibrosis is a strong predictor of clinical outcomes following liver transplantation (LT), however, non-invasive fibrosis assessment remains challenging. Vibration controlled transient elastography has been used to detect hepatic fibrosis, however, it suffers from low positive predictive value. Recently, VCTE measurements have been supplemented by clinical data to improve its diagnostic accuracy, however, the diagnostic of such models in LT recipients is unknown.

*Methods: Adult LT recipients with a liver biopsy, VCTE and clinical data necessary to construct CPM (N=132) were included. Patients with more than mild alcohol consumption, rejection, active therapy for hepatitis C, cholestatic hepatitis, decompensated graft cirrhosis, dialysis and heart failure were excluded. The computation models evaluated included FAST, AGILE3, and AGILE4 scores, which now have been evaluated in chronic liver disease in non-LT patients. Diagnostic statistics for moderate [fibrosis stage 0-1 vs. 2-4] and advanced fibrosis [fibrosis stage 0-2 vs. 3-4] were determined using optimal cut-off using Youden index and cross-validated AUROC were compared using DeLong test.

*Results: The mean time from LT to liver biopsy was 99 months. The distribution of fibrosis stage 0, stage 1, stage 2, stage 3, and stage 4 was 49%, 41%, 3%, 8%, and 8%, respectively. For detection FAST both for moderate fibrosis (AUROC 0.88 [95% CI, 0.81, 0.96] vs. 0.65 [CI 95% 0.50, 0.79], p<0.001) and advanced fibrosis (AUROC 0.94 [95% CI 0.89, 0.99] vs. 0.53 [95% CI 0.50, 0.75] p<0.001). For detection of moderate and advanced fibrosis for AGILE3 (AUROC 0.90 and 0.92, respectively) and AGILE 4 (AUROC 0.90 and 0.89) were statistically similar to VCTE alone and each other. The negative predictive value (NPV) for detection of advanced fibrosis was 0.96, 0.86, 0.93, and 0.94 for VCTE, FAST, AGILE-3 and AGILE-4, respectively. Addition of clinical parameters to VCTE as done with FAST, AGILE did not improve positive predictive value (PPV), which ranged from 0.27 for FAST to 0.57 for AGILE-4 compared to 0.62 for VCTE alone

*Conclusions: Addition of clinical parameters such as age, serum AST value to VCTE as is done with recently validated FAST, AGILE-3 and AGILE-4 scores did not improve the diagnostic performance. These discordant findings compared to the general population likely reflect transplant specific biological changes (i.e. lower AST) that underscore the importance of developing transplant specific models.

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