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Updated: May 24, 2026

Implementation of Non-invasive Point of Care Transient Elastography for Evaluation of Liver Disease in Pediatric Populations with Cystic Fibrosis
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Physiological and Anatomical Alterations in Children with Liver Cirrhosis

Femke A Elzinga1,2, Samira Lier1, Paul R V Malik3

  • 1Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Pharmaceutical Research
|May 22, 2026
PubMed

Insights

Children with liver cirrhosis show physiological changes similar to adults, but hematocrit is notably lower in younger children. More pediatric data is needed for accurate physiologically based pharmacokinetic (PBPK) models.

Area of Science:

  • Pharmacokinetics
  • Pediatric Gastroenterology
  • Biomedical Modeling

Background:

  • Liver cirrhosis in children presents unique physiological and anatomical challenges.
  • Physiologically based pharmacokinetic (PBPK) models are crucial for understanding drug behavior in pediatric populations.
  • Existing PBPK models for liver cirrhosis are primarily based on adult data.

Purpose of the Study:

  • To evaluate physiological and anatomical changes in pediatric liver cirrhosis.
  • To inform the development of PBPK models for children with liver cirrhosis.
  • To identify age-specific differences in physiological parameters compared to adults.

Main Methods:

  • Conducted a literature review of studies on pediatric liver cirrhosis parameters (December 2023-May 2024).
  • Analyzed physiological and anatomical data, stratifying by age and disease severity (Child-Pugh, MELD/PELD).
  • Compared pediatric data with established adult PBPK model parameters.

Main Results:

  • Albumin, GFR, liver/renal blood flow, and cardiac index showed trends comparable to adults or lacked sufficient pediatric data.
  • Hematocrit was significantly lower in children aged 2 to <6 years (P=0.022), with a greater fractional decline than adults.
  • Developmental and nutritional factors may contribute to observed hematocrit differences.

Conclusions:

  • Pediatric liver cirrhosis shares some physiological trends with adults, but distinct age-specific differences exist.
  • Limited pediatric data hinders definitive conclusions for many parameters, impacting PBPK model accuracy.
  • Further age-specific research is essential to refine PBPK models and optimize pediatric drug therapy.
Abstract

Keywords:
liver cirrhosispediatricsphysiologically based pharmacokinetic modeling

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