Determinants of liver stiffness assessed by transient elastography in transfusion-dependent thalassemia

BACKGROUND: Liver stiffness measurement (LSM) assessed by transient elastography (TE) is a validated noninvasive tool for staging liver fibrosis. This cross-sectional study investigated the determinants of LSM in a well-managed cohort of patients with transfusion-dependent β-thalassemia (TDT). RESEARCH DESIGN AND METHODS: We included 163 TDT patients (42.06 ± 9.07 years; 46% females) enrolled in the Extension-Myocardial Iron Overload Network. All participants underwent magnetic resonance imaging (MRI) for iron quantification within three months of TE. Endocrine complications were defined according to established clinical criteria. RESULTS: Mean LSM was 6.78 ± 3.49kPa, and advanced fibrosis (LSM ≥ 8kPa) was identified in 23.3% of patients. LSMs were significantly higher in patients with chronic hepatitis C virus (HCV) infection compared with those who were never infected or had cleared HCV, and in patients with at least one endocrinopathy compared with those without. LSMs correlated positively with body mass index and with mean serum levels of ferritin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT). No association was observed between LSM and MRI-derived liver iron concentration. Multivariate regression analysis identified chronic HCV infection, AST, and GGT as independent predictors of LSM. CONCLUSIONS: Chronic HCV infection and markers of hepatocellular injury were the main determinants of liver stiffness, underscoring the multifactorial nature of liver fibrosis in TDT.