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NAFLD and Liver Transplantation in Children-Working Group Report From the ILTS Single Topic Conference on NAFLD

Mara Cananzi1, Pietro Vajro2, Mohamed Rela3

  • 1Unit of Paediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, University Hospital of Padova, Padova, Italy.

Transplantation
|October 19, 2018
PubMed

Insights

Nonalcoholic fatty liver disease (NAFLD) is common in children, but rarely requires liver transplantation. Further research is needed on its natural history and transplantation indications in pediatric patients.

Area of Science:

  • Pediatric Hepatology
  • Liver Transplantation
  • Metabolic Disorders

Background:

  • Nonalcoholic fatty liver disease (NAFLD) is a prevalent cause of pediatric chronic liver disease.
  • Exclusion of secondary causes, such as inherited metabolic defects, is crucial in pediatric NAFLD cases.
  • Liver transplantation is an infrequent treatment for NAFLD in children, contrasting with adult populations.

Purpose of the Study:

  • To review the current evidence and knowledge regarding pediatric NAFLD.
  • To focus on the role and indications of liver transplantation in children with NAFLD.
  • To develop best practice recommendations for managing pediatric NAFLD.

Main Methods:

  • A pediatric working group of hepatologists and a liver transplant surgeon was formed.
  • A systematic review of English literature on pediatric NAFLD (birth to 18 years) from 2000-2018 was conducted.
  • Evidence was evaluated and discussed by the group to formulate recommendations.

Main Results:

  • High/moderate strength recommendations were possible for NAFLD risk factors and medical treatment due to available evidence.
  • The quality of evidence regarding the natural history and indications for liver transplantation in pediatric NAFLD was poor.
  • No definitive recommendations could be made concerning the natural history or transplantation for pediatric NAFLD.

Conclusions:

  • Nonalcoholic fatty liver disease is a rare indication for liver transplantation in children.
  • There is a significant lack of high-quality evidence on the natural history and transplantation outcomes for pediatric NAFLD.
  • Further research is essential to establish clear guidelines for liver transplantation in pediatric NAFLD cases.
Abstract

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