Steatotic liver disease after pediatric liver transplantation

Abstract

International audienceMetabolic dysfunction–associated steatotic liver disease is becoming an increasingly frequent cause of chronic liver disease in children. It has been reported as a complication of liver transplantation in adults but remains poorly evaluated in liver-transplanted children. The aim of this study was to assess the prevalence and characteristics of steatotic liver disease in a large cohort of liver-transplanted children and to identify factors associated with it. In this single-center study of patients with pediatric liver transplants (n=122) with a median follow-up time of 14.0 years, steatosis was found in 41 protocol biopsies (33.6%). The median time to the discovery of steatosis was 5.0 years posttransplantation, with a median age of 9.0 years at the time of diagnosis. Steatosis was predominantly mild to moderate and tended to resolve spontaneously on subsequent biopsies (48.8% of cases showed resolution). Steatosis mostly corresponded to metabolic dysfunction–associated steatotic liver disease (56.1%), but other patients had cryptogenic steatosis. The study found no association between the presence of steatosis and the immunosuppressive regimen, but a significant association between the onset of steatosis and an older donor age ( p <0.001). Therefore, steatotic liver disease is a noteworthy histological feature during the follow-up of pediatric liver transplant recipients, yet it had a low burden on the health of the patients in this cohort. However, it needs to be monitored in the context of the increasing prevalence of metabolic syndrome