Advancing precision hepatology for rare paediatric liver diseases

Rare genetic liver disorders pose a significant burden due to their chronic nature, early morbidity, and frequent need for liver transplantation. Despite advances in diagnostic tools, these conditions are often misdiagnosed or diagnosed late due to non-specific symptoms, which overlap with more common aetiologies. The advent of next-generation sequencing has revolutionised the diagnosis of these disorders, enabling precise genetic identification, reducing diagnostic delays, enabling application of targeted therapies, and informing prognosis and family counselling. This opinion article highlights the clinical challenges in diagnosing paediatric cholestasis, emphasising the critical role of genetics-driven approaches, including comprehensive variant databases, functional genomics, multi-omics integration, and organoid-based disease modelling to enhance diagnostic accuracy and uncover therapeutic targets. Additionally, it discusses the global disparities in early diagnosis, exemplified by delayed recognition of d settings, and underscores the need for public health initiatives, such as newborn genomic screening and international collaboration, to improve equitable access to precision diagnostics and management of rare liver diseases.

Together, these advances have the potential to accelerate the transition toward precision hepatology, enabling earlier diagnosis, personalized therapies, and improved outcomes for children with rare genetic liver disorders.

• Next-generation sequencing has transformed the diagnosis of rare pediatric liver disorders by improvingdiagnostic yield and enabling precision medicine.

• Strategies to integrate genomics with functional disease modelling and ensure equitable access to precisiondiagnostics are still lacking, limiting clinical translation and patient outcomes.