FibroScan Liver Stiffness Strongly Predicts Outcomes in PSC: Gastroenterology | August 2026

Introduction:

Risk stratification in primary sclerosing cholangitis (PSC) remains challenging because conventional biochemical markers do not reliably predict disease progression. The international FICUS cohort evaluated whether VCTE-based liver stiffness measurement (LSM) and its change over time could predict death or liver transplantation in compensated PSC.

Why was this study needed?

PSC has a highly variable clinical course.

ALP and conventional markers provide imperfect prognostic information.

A simple, non-invasive tool for long-term risk stratification is needed.

Serial LSM may capture disease progression better than a single measurement.

Key Findings:

The study followed 538 adults with compensated PSC across 13 centres in 11 countries.

Five-year transplant-free survival was 93.9% with LSM <10 kPa.

Survival declined to 78.1% with LSM 10–<15 kPa and only 46.0% with LSM ≥15 kPa.

Increasing liver stiffness over time provided additional prognostic information.

Patients with significant LSM progression had approximately 3-fold greater risk of death or liver transplantation.

Each 1 kPa/year increase in liver stiffness was associated with an 18% increase in risk.

Serial FibroScan may therefore help identify patients requiring closer surveillance and earlier transplant assessment.

Importantly, liver stiffness did not reliably predict cholangiocarcinoma.

Bottom Line:

FibroScan provides powerful, practical prognostic information in compensated PSC. Both absolute liver stiffness and its trajectory over time may help identify patients at high risk of death or transplantation.