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Publications

Journal Article Ahead of print

PubMed: 42555009 DOI: 10.1080/17474086.2026.2715465

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

Expert Rev Hematol

Authors: Antonella Meloni, Paolo Ricchi, Laura Pistoia, Filomena Longo, Maria Caterina Putti, Anna Spasiano, Vincenza Rossi, Alberto Cossu, Priscilla Fina, Giuseppe Peritore, Vincenzo Positano, Andrea Barison

Affiliations

  • Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
  • Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale "A. Cardarelli", Napoli, Italy.
  • Unità Operativa Complessa Ricerca Clinica, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
  • Unità Operativa Complessa Talassemie ed Emoglobinopatie, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, Ferrara, Italy.
  • Dipartimento della Salute della Donna e del Bambino Clinica di Emato-Oncologia Pediatrica, Azienda Ospedaliero-Università di Padova, Padova, Italy.
  • Unità Operativa Complessa Ematologia, Ospedale di Cosenza, Cosenza, Italy.
  • Unità Operativa Radiologia Universitaria, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, Ferrara, Italy.
  • Unità Operativa Complessa Diagnostica per Immagini, Ospedale "Sandro Pertini", Roma, Italy.
  • Unità Operativa Complessa di Radiologia, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico "Benfratelli-Di Cristina", Palermo, Italy.
  • Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.

Abstract

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.

MeSH

Research Design, Fibrosis, Elasticity Imaging Techniques, Transferases, Transaminases, Liver, Thalassemia, Infections, Liver Stiffness