Role of FibroScan in evaluating hepatic involvement in systemic amyloidosis: a single-centre prospective pilot study

Amyloidosis encompasses a group of diseases characterised by extracellular deposition of misfolded protein fibrils, potentially leading to organ dysfunction. Liver involvement occurs via direct amyloid infiltration, common in immunoglobulin light chain (AL) amyloidosis, or congestive hepatopathy, more typical in transthyretin (ATTR) amyloidosis. The utility of liver stiffness measurement (LSM) using FibroScan as a non-invasive alternative to liver biopsy remains uncertain.

To prospectively evaluate the utility of Fibroscan in diagnosing and monitoring for hpeatic infiltratioin in AL and ATTR amyloidosis.

This pilot prospective study included 14 patients with newly diagnosed amyloidosis at a single centre. Liver involvement was evaluated via FibroScan, liver function tests, liver ultrasound and cardiac biomarkers at baseline and follow-up over 24 months. LSM trends were then descriptively analysed.

Five patients (35.7%) - three ATTR and two AL amyloidosis - had baseline LSM >10 kPa, suggestive of increased liver stiffness. AL amyloidosis patients exhibited higher LSM values (>17.3 kPa) despite normal ALP levels. LSM improved in 60% of treated patients. No observable association was found between ALP levels and LSM trends. In ATTR amyloidosis patients, LSM >10 kPa was associated with advanced Gilmore stage and elevated NT-proBNP.

This pilot study suggests LSM may provide a useful early non-invasive adjunct in the assessment of hepatic involvement in amyloidosis; however, it should be interpreted as a non-specific marker. Larger studies are required to validate the diagnostic and prognostic role of FibroScan in this population.