Liver and Spleen Stiffness as Non-Invasive Tools Assessing Liver Congestion in Patients With Budd-Chiari Syndrome: GI Signals

Hepatology retrospective · n=66 · Oct 1, 2026 · Liver International · IF 6.7

Liver and Spleen Stiffness as Non-Invasive Tools Assessing Liver Congestion in Patients With Budd-Chiari Syndrome.

New evidenceportal hypertensionbiomarkerepidemiology

Clinical takeawayConsider using liver stiffness measurement (LSM) by transient elastography to monitor clinical status in Budd-Chiari syndrome, with a cut-off of 25 kPa to distinguish controlled from uncontrolled disease. SSM may provide complementary information but does not outperform LSM.

What it foundLiver stiffness measurement (LSM) by transient elastography discriminated controlled vs. uncontrolled clinical status in Budd-Chiari syndrome with AUC 0.985, and a cut-off of 25 kPa yielded 97.5% sensitivity and 92.5% specificity. Spleen stiffness measurement (SSM) showed good discrimination (AUC 0.854), with values ≤30 kPa ruling out and >40 kPa ruling in uncontrolled status, though accuracy was inferior to LSM. LSM values rapidly decreased following liver congestion resolution after interventional procedures.

ContextThis confirms and refines the utility of transient elastography in Budd-Chiari syndrome, providing a specific cut-off for clinical decision-making, which was previously lacking. The rapid decrease in LSM after successful treatment highlights its potential for monitoring treatment response.

Emergingsuggested applicable standard· European Association for the Study of the Liver (EASL), "EASL Clinical Practice Guidelines on vascular diseases of the liver," Journal of Hepatology, 2025

Budd-Chiari syndrome (primary hepatic venous outflow obstruction): initiate therapeutic anticoagulation as soon as possible after diagnosis and continue it indefinitely unless contraindicated (strong recommendation), LMWH initially, transitioned to a vitamin K antagonist targeting INR 2-3; DOACs such as apixaban are increasingly used but rest on more limited evidence, so use them cautiously in advanced liver disease. …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

Budd-Chiari syndrome (primary hepatic venous outflow obstruction): initiate therapeutic anticoagulation as soon as possible after diagnosis and continue it indefinitely unless contraindicated (strong recommendation), LMWH initially, transitioned to a vitamin K antagonist targeting INR 2-3; DOACs such as apixaban are increasingly used but rest on more limited evidence, so use them cautiously in advanced liver disease. Concurrently identify and treat the underlying cause after a comprehensive thrombophilia/myeloproliferative-neoplasm workup (including JAK2 V617F). Manage the outflow obstruction with a response-guided stepwise strategy, escalating only in patients who do not respond to medical therapy: percutaneous angioplasty/stenting for short-segment venous stenosis, then TIPS for non-correctable outflow obstruction with persistent portal hypertension or clinical deterioration, and liver transplantation for a fulminant presentation or failure of/contraindication to TIPS. Sinusoidal obstruction syndrome, treated with defibrotide, e.g. after HSCT, and acute mesenteric venous thrombosis, a surgical emergency when bowel ischemia is present, are distinct disorders with their own management pathways and are not steps in this Budd-Chiari algorithm.

European Association for the Study of the Liver (EASL), "EASL Clinical Practice Guidelines on vascular diseases of the liver," Journal of Hepatology, 2025 · reviewed 2026-07-20 ↗

Fodor A … García-Pagan JC · Liver International : Official Journal of the International Association for the Study of the Liver · IF 6.7 · PubMed ↗Permalink