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Steatotic liver disease after pediatric liver transplantation
Emma Wischlen1, Olivier Boillot2,3,4, Christine Rivet1
1Department of Paediatric Hepatogastroenterology and Nutrition, and Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Lyon, France.
Insights
Metabolic dysfunction-associated steatotic liver disease is increasingly seen in children post-liver transplant. While often mild and resolving, it requires monitoring due to metabolic syndrome prevalence.
Area of Science:
- Pediatric Hepatology
- Transplantation Medicine
- Gastroenterology
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing cause of pediatric chronic liver disease.
- MASLD is a known complication in adult liver transplant recipients but is understudied in children.
Purpose of the Study:
- To determine the prevalence and characteristics of steatotic liver disease in pediatric liver transplant recipients.
- To identify factors associated with the development of steatosis in this population.
Main Methods:
- A single-center study analyzed 122 pediatric liver transplant patients with a median follow-up of 14 years.
- Protocol biopsies were used to assess steatosis, with subsequent biopsies tracking resolution.
- Statistical analysis identified factors associated with steatosis onset.
Main Results:
- Steatosis was detected in 33.6% of patients, typically mild to moderate, appearing a median of 5 years post-transplant.
- MASLD accounted for 56.1% of cases; 48.8% of steatosis resolved spontaneously.
- Older donor age was significantly associated with steatosis onset (p <0.001); immunosuppression showed no association.
Conclusions:
- Steatotic liver disease is a notable histological finding in pediatric liver transplant recipients, generally with a low health burden in this cohort.
- Regular monitoring is recommended, especially considering the rising incidence of metabolic syndrome.
Abstract:
Metabolic 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.
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