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In addition, LB is difficult to justify for repeated assessment. Noninvasive tests (NIT) have been developed to substitute LB. They are patient friendly and simple procedures [10]. NIT evaluating fibrosis are of two types [11]. The first are serum markers: direct and indirect [10]. Indirect NIT comprise routine tests, age, platelet count, ��GT, cholesterol (Forns�� index) [12] or AST/platelet count (APRI index) [13], or a2-macroglobulin, haptoglobin, gamma globulin, apolipoprotein, bilirubin (Fibrotest) [14]. Direct NIT measure extracellular matrix components (glycoproteins, collagen IV, pro-collagen III) [15]. Some scores combine direct and indirect NIT. The second type of NIT derive from liver imaging [11]. Transient elastography (TE) based on ultrasound technology, measures http://www.selleckchem.com/products/chir-99021-ct99021-hcl.html hepatic elasticity-a surrogate of fibrosis [16,17]. Intra- and inter-observer agreement is 98% [18] in pre-LT settings. http://www.selleckchem.com/products/Y-27632.html There are few studies in liver transplant recipients, in whom evaluating of liver fibrosis during recurrent viral infection would be useful. Currently, serial liver biopsies are used to assess progression or severity of graft disease. However, the diagnostic accuracy of NIT could be reduced in transplant settings due to the possibility of multiple aetiologies for graft damage. Systematic evaluation of the literature regarding NIT assessing fibrosis due to recurrent HCV after LT. We used Medline/PubMed and Embase databases using the search terms ��noninvasive�� test, ��transient elastography�� and ��liver transplantation��, in all languages. http://www.selleck.cn/products/BKM-120.html Two authors (EC, ET) identified 171 articles independently and conducted a manual search of reference lists and abstracts of Hepatology and Transplant congresses. We identified 14 full articles [19�C32] and four abstracts [33�C36] in which liver biopsy was used as the reference investigation for fibrosis assessment. Special populations of HCV patients (e.g. renal transplant recipients) were excluded. All studies published as full papers had very good scores of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) for systematic review [37], while the four studies published in abstract scored badly [33�C36]. Thus, we evaluated only the 14 full articles [19�C32] (Table?1) excluding the four abstracts. However, we performed a sensitivity analysis in order to establish if the results would change if the abstracts were included. Studies including recipients with other aetiologies of liver disease were included if data for HCV infected patients could be extracted. EC and ET performed data abstraction and any conflicts were arbitrated by AKB. We defined significant fibrosis as fibrosis stage ��2 for grading systems with 5 (F0�CF4) stages (METAVIR, Knodell, Scheuer score and Desmet scores) and fibrosis stage ��3 for Ishak score. The Mann�CWhitney U-test was used to compare the performance of NIT. Significance testing was two sided and set at P?