Liver Stiffness kPa to Metavir Fibrosis Stage Conversion
Disease-specific conversion tables for MAFLD/MASLD, Hepatitis B (HBV), and Hepatitis C (HCV). Thresholds differ by aetiology — always use the correct table.
Important: kPa thresholds vary by disease aetiology, elastography system, and guideline version. These tables reflect commonly used EASL/GESA-based thresholds. Always interpret in the clinical context and refer to current guideline versions for definitive staging decisions. Thresholds for guided TE and 2D-SWE systems may differ slightly from VCTE (FibroScan) thresholds in some studies.
MAFLD / MASLD (Metabolic Fatty Liver Disease)
Based on GESA MAFLD clinical guidelines and EASL consensus. These are the most commonly encountered thresholds in Australian primary care.
| LSM (kPa) | Metavir Stage | Interpretation | Recommended Action |
|---|---|---|---|
| < 8.0 kPa | F0–F1 | No or mild fibrosis | Monitor. Repeat FIB-4 in 1–2 years. |
| 8.0–10.0 kPa | F1–F2 | Mild to moderate fibrosis | Optimise metabolic risk. Consider specialist. |
| 10.0–12.0 kPa | F2–F3 | Moderate to significant fibrosis | Specialist referral recommended. |
| 12.0–15.0 kPa | F3 | Advanced fibrosis | Refer to hepatologist. |
| > 15.0 kPa | F3–F4 | Advanced fibrosis / cirrhosis | Urgent specialist referral. |
Hepatitis B (HBV)
HBV thresholds differ from MAFLD — liver inflammation in active HBV can raise LSM independent of fibrosis. Interpret during virological suppression where possible.
| LSM (kPa) | Metavir Stage | Interpretation | Recommended Action |
|---|---|---|---|
| < 6.0 kPa | F0–F1 | No or mild fibrosis | Monitor per GESA HBV guidelines. |
| 6.0–9.0 kPa | F1–F2 | Mild to moderate fibrosis | Consider treatment initiation threshold. |
| 9.0–12.0 kPa | F2–F3 | Significant fibrosis | Treat if not already on therapy. |
| > 12.0 kPa | F3–F4 | Advanced fibrosis / cirrhosis | Treat. Cirrhosis surveillance required. |
Hepatitis C (HCV) — Post-Treatment Monitoring
These thresholds apply pre-DAA treatment and for post-SVR monitoring. LSM typically falls post-SVR but may remain elevated in established cirrhosis.
| LSM (kPa) | Metavir Stage | Interpretation | Recommended Action |
|---|---|---|---|
| < 7.0 kPa | F0–F1 | No or mild fibrosis | Treat with DAA. Monitor post-SVR. |
| 7.0–9.5 kPa | F2 | Moderate fibrosis | Treat. Post-SVR elastography at 6 months. |
| 9.5–12.5 kPa | F3 | Advanced fibrosis | Treat urgently. Cirrhosis surveillance post-SVR. |
| > 12.5 kPa | F4 | Cirrhosis | Treat. Lifelong cirrhosis surveillance required regardless of SVR. |
Important Notes on kPa Interpretation
- Inflammation elevates LSM: Active hepatitis (elevated ALT/AST) can raise liver stiffness independent of fibrosis. Interpret during periods of disease stability where possible.
- Congestion elevates LSM: Right heart failure and hepatic venous congestion increase liver stiffness significantly — elastography in these patients may not reflect fibrosis.
- Post-prandial state: LSM is higher within 2 hours of a large meal. Standard protocol is fasting for 2–4 hours pre-examination.
- System-specific thresholds: Published cutoffs may differ between VCTE (FibroScan) and guided TE or 2D-SWE systems. Most published data uses VCTE. Clinically, the difference is generally not large enough to change management.
- Baveno VII monitoring threshold: A change of ≥5 kPa between measurements is considered clinically meaningful for longitudinal monitoring (progression or regression).