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SummaryThe correlation between liver stiffness, measured by transient elastography, liver fibrosis, using the histological METAVIR score, and iron overload, measured by atomic absorption spectrometry was evaluated in 56 homozygous-b-thalassaemics. Liver stiffness increased proportionally to liver fibrosis staging (r = 0AE70; P > 0AE001) independently of liver iron concentration (r = 0AE01; P = 0AE932). The area under the receiver-operating characteristic curve for prediction of cirrhosis was 0AE997 (95% confidence interval [CI]: 0AE925-1AE000) with cut-off of 13 kPa with 100% sensitivity (95% CI: 69AE0-100AE0) and 95% specificity (95% CI: 84AE2-99AE3). Transient elastography is a reliable non-invasive tool for diagnosing advanced liver fibrosis in homozygous-b-thalassaemics, regardless of the degree of iron overload.