Baveno VIII Consensus
- Update 2026

These new Baveno VIII guidelines further reinforce FibroScan^® as the reference non-invasive platform across the entire portal hypertension pathway for the management of patients with advanced chronic liver disease independent of etiology.

➜ cACLD is a LSM by VCTE^® based definition spanning severe fibrosis to cirrhosis, used to identify patients at risk of CSPH, decompensation, and liver-related death at point of care, distinct from «compensated cirrhosis».

➜ LSM by VCTE^® is endorsed as the cornerstone NIT for risk stratification in cACLD and improved clinical decision making for patients at risk of CSPH, decompensation and liverrelated mortality.

➜ The «Rule of 5» for LSM by VCTE^® (10-15-20-25 kPa) is reaffirmed and strengthened, with each 5 kPa increase associated with a stepwise increase in the risk of decompensation and liver-related death.

➜ SSM by VCTE^® (100Hz) role is significantly expanded in Baveno VIII, moving form an adjunctive tool to a key complement to improvement CSPH classification with clear cutoffs.

➜ Baveno VIII marks a further shift from diagnosing portal hypertension to predicting clinical outcomes, recommending serial non-invasive monitoring with LSM- and SSM-based algorithms to identify patients at risk of first decompensation and enable preventive treatment.

➜ The updated recommendations continue to rely predominantly on cut-offs validated with FibroScan^® (VCTE^®), providing a unique level of evidence supporting the use of FibroScan^® in routine clinical practice and specialized liver centers.

➜ Baveno VIII endorses FibroScan^® for the non-invasive monitoring of recompensated cirrhosis, with LSM and SSM cut-offs used to assess CSPH resolution or persistence.

➜ As with previous Baveno conferences, no equivalent diagnostic cut-offs are recommended for other elastography technologies (2D-SWE, pSWE and non-VCTE) on both liver stiffness & spleen stiffness.

Identification of cACLD

• LSM by VCTE < 10kPa in the absence of other known clinical/imaging signs rule out cACLD; values between 10 and 15 kPa are suggestive of cACLD; values > 15 kPa are highly suggestive of cACLD.

Diagnosis of CSPH

• LSM by VCTE ≤ 15 kPa plus platelet count ≥ 150×109/L rules out CSPH in cACLD patients.

• In patients with virus and/or alcohol related cACLD and non-obese (BMI <30 kg/m2) MASLDrelated cACLD, LSM by VCTE ≥ 25 kPa is sufficient to rule in CSPH.

• In patients with MASLD and obesity, an estimated CSPH probability ≥ 75% by ANTICIPATE/ANTICIPATE-NASH or NICER models can establish diagnosis of CSPH.

• In patients with cACLD, SSM (100Hz) by VCTE ≥ 55 kPa can be used to rule in CSPH.

Triage for screening endoscopies

• Patients with cACLD who are ineligible for NSBB to prevent decompensation should undergo EGD to screen for varices unless LSM by VCTE < 20 kPa and platelet count ≥150×109/L.

• SSM by VCTE < 40 kPa, can safely avoid screening endoscopy in selected patients.

Reassess over time

• In patients with cACLD, LSM and SSM by VCTE^® should be repeated every 12 months for CSPH assessment.

Clinically meaningful change

• A confirmed ≥30% relative change in LSM by VCTE^® signals a clinically meaningful change in the risk of liver-related events, in both MASLDand alcohol-related cACLD.

• In MASLD, particularly when crossing the LSM by VCTE 15 kPa threshold.

Predict decompensation and liver-related outcomes

The rule of five

• A rule of five for LSM by VCTE® (10-15-20-25 kPa) denotes progressively higher relative risks of decompensation and liver-related death independently of the etiology of CLD. (See figure 1)

Recompensated cirrhosis

• In recompensated cirrhosis, LSM < 10 kPa or LSM < 15 kPa AND SSM < 25 kPa may help rule out CSPH while LSM > 25 kPa may rule-in CSPH.

Patients with Hepatocellular carcinoma (HCC)

• In patients with cACLD and Barcelona Clinic Liver Cancer (BCLC) stages 0-C, LSM ≤ 15 kPa and PLT ≥ 150×109/L rule out CSPH and EGD may be avoided.

• In patients with cACLD and BCLC stages 0-A without large (>5cm) nodules in the right liver lobe, an estimated probability of CSPH ≥75% by ANTICIPATE/ANTICIPATE-NASH may be highly suggestive of CSPH.

• With macrovascular invasion, NITs may not apply.

Pediatric portal hypertension

• LSM is a valuable complementary tool that enables the non-invasive identification of children at risk for portal hypertension due to Advanced chronic liver disease and helps to monitor disease progression.

• In pediatric patients, LSM and SSM cut-offs for identifying varices require further validation and should not be used alone for portal hypertension
  management.