What liver research gap did this study address?
Every case of PSC is different. There is no straight road that each person with PSC takes from the first autoimmune response to needing a liver transplant. This causes significant challenges for healthcare professionals and researchers.
Tests that can predict which cases of PSC will be more severe are very important tools for the treatment of the disease. Being able to predict the course of the disease in an individual can lead to better care and potentially better outcomes. This is especially important for predicting who needs a liver transplant more urgently.
What were the aims of this PSC study?
In 2023 these researchers put out a report suggesting that low levels of vitamin B6 in people with PSC could be used to predict the need for a liver transplant. This initial study only used data from a population of Norwegians.
This 2026 report had two aims:
- To test if these results could be repeated in other groups of people from other parts of the world,
- And to see whether low levels of vitamin B6 could predict liver decompensation (severe liver damage).
How was the research conducted?
This was a retrospective study. This means that the researchers used old patient records and samples to gather all the data they required.
They used data from one Norwegian hospital, one German hospital and a varied group of samples and records from the USA. Using these samples, they measured vitamin B6 levels and compared these to patient records showing liver decompensation, liver transplant or death. The German samples were only used to compare liver decompensation.
What were the main findings of the study?
This study, comparing vitamin B6 levels to PSC development in 3 different populations, had similar results to the research team’s 2023 Norwegian study.
The findings of the 2026 study were:
- In the general populations of Norway, Germany and the USA, vitamin B6 deficiency (low vitamin B6) is very rare. However, in the PSC populations studied, it was quite common, with an average of 38% of people having vitamin B6 deficiency across the three country groups.
- The PSC patients with vitamin B6 deficiency had worse disease markers compared to PSC patients with adequate to sufficient levels of vitamin B6. The low vitamin B6 blood samples showed:
- Low levels of vitamin B6 were linked to:
- Greater chances of a liver transplant
- Increase in PSC-related death
- And increased liver decompensation
- Liver transplant and death results were measured in both the Norwegian and American groups, while liver decompensation results were measured in the German, Norwegian and American groups.
- As a predictor of PSC disease development, vitamin B6 levels gave better results than other prediction analyses used in other studies.
- After a liver transplant vitamin B6 levels did not increase in many people. The researchers suggested the vitamin B6 levels in people with PSC could be influenced by the microbiome.
- The risk of liver transplant or death increased when vitamin B6 levels were ‘deficient’ (very low) or ‘marginally deficient’ (low). When vitamin B6 levels increased beyond this, the risk decreased and then plateaued.
Why are these research results important for PSC?
These results reinforced the 2023 Norwegian study which linked low vitamin B6 to greater risk of liver transplant and death in people with PSC. The current study found this link in 2 different countries and the link with liver decompensation in 3 different countries. The 2023 results were important; these 2026 results are more important.
Finding these results in at least 2 different countries gives them more strength. People with different genetic backgrounds, lifestyles and many other differences all had the same link: low vitamin B6 is associated with worse PSC outcomes.
The other big result was that vitamin B6 levels seemed to be a better predictor for PSC outcomes than other commonly used tests. If this result could be repeated in a trial using actual people instead of old blood tests and records; it could lead to better testing for people with PSC. Improving prioritisation of liver transplants for those who need them most.
What does this mean for people with PSC?
This study linked low vitamin B6 levels to those in greatest need of a liver transplant. It did not look at how supplementing with vitamin B6 affects PSC, and did not give any evidence that supplementing could change the progression of the disease. Vitamin B6 may not have any effect at all on PSC outcomes; it may purely be a marker for whatever is causing the problem. This area needs more research. You should always discuss taking supplements with your doctor before taking anything new.
Next Steps
This was a retrospective study. Generally, this means that the evidence found is not strong enough to be used clinically. The results will not directly affect how your doctor will offer you care. However, this study has given some strong leads for future research to follow. A potential next step that could lead to future treatment improvements for PSC is:
- Following up with clinical trials including people with PSC to get stronger evidence that vitamin B6 levels can be used to predict the disease’s development.
Many thanks to Geoff Churchill for this summary.