Does transient elastography correlate with liver fibrosis in patients with PSC? Laennec score-based analysis of explanted livers

<p><b>Background and aims:</b> Previous studies demonstrated a close correlation between transient elastography (TE) and liver histology in chronic liver diseases. Data on the accuracy of TE in primary sclerosing cholangitis (PSC) remains scarce. Here, we investigated the association between TE, serum marker of liver injury and histology of explanted livers in PSC patients.</p> <p><b>Methods:</b> Thirty patients were prospectively recruited. TE (Fibroscan^®) and blood sampling were performed during evaluation for liver transplantation (LT); the second blood sampling was performed on the day of LT. Fibrosis of explanted livers according to the seven-point Laennec staging system and liver collagen contents were measured.</p> <p><b>Results:</b> TE correlated with Laennec stages of fibrosis (<i>p</i> = .001), collagen contents (<i>p</i> < .001) and with diameter of thickest septa (<i>p</i> = .034) in explanted livers. It also correlated with serum indices of liver injury, namely AST, bilirubin as well as FIB-4 and APRI scores (all <i>p</i> < .05). In a multivariate model, only liver fibrosis, according to either Laennec score (<i>p</i> = .035) or collagen contents (<i>p</i> = .005), was significantly associated with TE. Finally, patients with cirrhosis had increased liver stiffness (<i>p</i> = .002) and the TE cut-off of 13.7 kPa showed the best predictive value (AUC = .90, 95% CI: 0.80–1.00, <i>p</i> < .001) for detecting cirrhosis.</p> <p><b>Conclusions:</b> TE correlates with liver fibrosis and markers of liver injury in patients with PSC. However, liver fibrosis seems to be the strongest predictor of liver stiffness assessed with TE. Hence, we postulate that TE is a reliable tool for non-invasive monitoring of PSC.</p