Liver stiffness was determined by transient elastography with use of a Fibroscan machine (EchoSens) [9 (link), 11 (link)]. In brief, an ultrasound transducer probe is mounted on the axis of a vibrator; vibrations of mild amplitude and low frequency induce an elastic shear wave that propagates through underlying liver tissue. Pulse-echo ultrasound acquisitions are used to follow propagation of the shear wave and measure its velocity. Results are instantaneously received as a single, quantitative parameter of liver stiffness measurement, reported in kilopascals. All elastography examinations were performed by certified operators (who were trained by the manufacturer) with use of a single device in the research clinic; the methods are described elsewhere [11 (link)]. Examinations with 8 validated measurements and a ≥60% success rate (the number of validated measurements divided by the total number of measurements) were considered to be reliable. During training, examinations were performed sequentially by 2 operators for 47 patients; the median interobserver difference was 0.0 kPa (interquartile range [IQR], −1.45 to 1.25 kPa).