Liver stiffness measurement using Fibroscan® is an effective tool for risk stratification in primary sclerosing cholangitis (PSC).

• Baseline liver stiffness shows strong correlation with transplant-free survival: 5-year survival rates were 93.9% (<10 kPa), 78.1% (10-15 kPa), and 46.0% (>15 kPa).
• Progressors (increasing stiffness) had worse outcomes: an adjusted hazard ratio of 3.12 for death or transplantation.

Monitoring liver stiffness can guide surgical decisions and patient selection for liver transplantation.