Title: Perinatal and lifestyle factors associated with childhood alanine aminotransferase levels as an early indicator of MASLD: a population-based study  

Source: The Journal of Pediatrics 2026, May 12. [E–publication]  

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Date of publication: May 2026  

Publication type: Population-based study

Abstract: Objective: To investigate associations of perinatal and lifestyle factors with alanine aminotransferase (ALT) levels as an early indicator of metabolic dysfunction-associated steatotic liver disease (MASLD).

Study design: Data from the population-representative longitudinal PANIC study, conducted among Finnish schoolchildren (n=736), were utilized. Three visits during childhood included comprehensive assessments of metabolic biomarkers, body composition, and lifestyle factors. Perinatal data were obtained from registries and questionnaires. Altogether, 488 children were included in mid-childhood (ages 7-8), 421 in late childhood (9-11), and 255 in adolescence (15-17). The predefined primary outcome was plasma ALT level, used as a biomarker of early-stage MASLD.

Results: In mid-childhood and adolescence, significant associations (P <0.05) between the children’s ALT were detected for pre-pregnancy hypertension (β=0.155-0.157). In late childhood, higher waist-to-height ratio and visceral adiposity by DXA became positively associated with ALT independent of body mass index standard deviation score (β=0.246-0.377). In adolescence, higher insulin levels and dyslipidemia (0.184-0.378) were positively associated with ALT. In late childhood, intake of protein, and animal and dairy products (β=0.121-0.184), and in adolescence, intake of protein and fish (β=0.154-0.280) were positively associated with ALT, and intake of vegetables, fruit and berries and fructose (β=-0.135 to -0.141) showed a negative association. In mid- and late childhood, levels of phenylalanine and branched-chain amino acids (β=0.131-0.248), and in adolescence, those of omega-3/6 (β=-0.103 to 0.198) and all fatty acids (β=0.197-0.228) were all positively associated with ALT. Sleep or measured physical activity were not associated with ALT. Several associations attenuated after multiple-testing correction for false discovery rate.

Conclusions: Maternal hypertension, offspring intake of protein, animal and dairy products, levels of phenylalanine, branched-chain amino acids and fatty acids, and offspring cardiometabolic risk factors correlated with elevated ALT as an indicator of MASLD. The findings underscore the importance of pre- and post-natal influences and support early prevention, although caution is warranted as associations were modest and reduced after adjustment for false discovery rate.

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Title: Living-donor liver transplantation in children with inherited metabolic and genetic cholestatic liver diseases: a single-center retrospective cohort study  

Source: Orphanet Journal of Rare Disease 2026, 21 (1): 183 

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Date of publication: April 2026 

Publication type: Single-center retrospective study

Abstract: Background: Living donor liver transplantation (LDLT) has become an important therapeutic option for children with selected inherited metabolic and genetic cholestatic liver diseases (IM-GCLDs).However, evidence on disease-specific outcomes across different diagnostic categories remains limited, and we therefore conducted a single-center retrospective study with contemporaneous non-IM-GCLD pediatric LDLT recipients as a comparator to better contextualize transplant-related outcomes and disease-specific benefits.

Results: Among 21 children with IM-GCLDs, the median follow-up was 21 months; two patients died (one perioperatively from disseminated intravascular coagulation and one at 21 months from pneumonia-related multiorgan failure), and all others are alive with functioning grafts. Disease-specific manifestations, including neuropsychiatric symptoms, portal hypertension, metabolic crises, cholestasis, hyperbilirubinemia, and hyperammonemia, improved or resolved in almost all survivors.At 6 months after LDLT, in children <10 years, mean weight- and height-for-age Z-scores increased from -0.48 to 0.43 and from -0.76 to -0.01; in children ≥10 years, mean height Z-scores increased from -1.49 to -0.53 while BMI Z-scores showed no significant change. Overall survival did not differ significantly between IM-GCLDs and non-IM-GCLD indications.

Conclusions: Living donor liver transplantation in children with IM-GCLDs not only improves survival but also confers disease-specific benefits, including recovery of neurologic function, metabolic stabilization, relief of portal hypertension and cholestasis, and catch-up growth. These findings support LDLT as an important therapeutic option for IM-GCLDs, while diagnosis-tailored perioperative assessment and long-term management remain essential given the phenotypic heterogeneity.

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Title: Clinical features of biliary atresia complicated by cytomegalovirus infection and prognostic analysis after Kasai portoenterostomy

Source: Journal of Pediatric Surgery 2026, May 8. [E–publication]

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Date of publication: May 2026 

Publication type: Retrospective study

Abstract: Objective: To explore the unique clinical characteristics of biliary atresia(BA)combined with cytomegalovirus infection and its impact on early and late prognosis after Kasai portoenterostomy(KPE).

Methods: This was a retrospective study involving children diagnosed with BA and treated with KPE at the Children’s Hospital of Jiangxi Province from January 2017 to October 2023. Based on the presence or absence of CMV infection, the patients were divided into a CMV infection group and a CMV non-infection group. The follow-up period ended on October 1, 2025, with a minimum follow-up duration of >2 years. Data were collected and analyzed, including basic characteristics, core disease features, core laboratory indicators, treatment-related indicators, surgical success within 3 months postoperatively, and native liver survival status after more than 2 years.

Results: A total of 70 BA patients were included, with 19 in the CMV infection group and 51 in the CMV non-infection group. In the CMV infection group, 31.6% (6/19) had successful surgery, while in the non-infection group, 47.1% (24/51) had successful surgery. In the CMV infection group,78.9% (15/19) experienced native liver failure (NLF), whereas in the non-infection group, 51.0% (26/51) experienced NLF. Differential analysis showed significant differences between the CMV infection group and the non-infection group in terms of age at admission, surgical age, hepatomegaly, surgical weight, GLO levels, AST levels, DBIL levels, gallbladder ejection fraction, postoperative antiviral treatment (P < 0.05), while no significant differences were found in gender, ALB, ALP, ALT, GGT, PLT, Splenomegaly, BASM, other associated malformations, BA anatomical classification, early postoperative cholangitis, and total postoperative steroid dose (P > 0.05). Univariate and multivariate analyses showed that CMV infection is an independent risk factor for long-term NLF postoperatively (HR = 1.988, 95% CI: 1.005,3.932, P = 0.049), but it had no significant effect on the short-term success rate of KPE (OR = 2.118, 95% CI: 0.644,6.967, P = 0.217). Kaplan Meier plotter showed that the cumulative incidence of NLF events was significantly higher in the CMV infection group, and the median native liver survival time was significantly shorter (Log-Rank P < 0.05).

Conclusion: BA patients with CMV infection exhibit clinical features such as delayed diagnosis and more severe liver damage. CMV infection does not specifically cause gallbladder “absence” or “functional abnormality” as a single defect, but rather more broadly interferes with the normal development of the biliary system, making it difficult for children to maintain an ideal state of “structurally intact and functionally normal.” Although CMV infection does not affect the early success rate of KPE, it is an independent risk factor for long-term NLF, significantly reducing the long-term survival rate of native liver in BA patients. Therefore, in the future, CMV status can be used as an important indicator for risk stratification and long-term follow-up of BA patients.

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Title: The impact of early allograft dysfunction severity on graft and recipient outcomes in pediatric liver transplantation

Source: Annals of Hepatology 2026, May 12. [E–publication]  

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Date of publication: May 2026 

Publication type: Retrospective study 

Abstract: Introduction and objectives: Early allograft dysfunction (EAD) substantially compromises graft and recipient outcomes; the clinical consequences of EAD vary according to severity. Research focusing on EAD in pediatric liver transplantation (pLT) remains notably limited. This study sought to validate the EAD severity grading models in pLT and assess the impact of varying severity grades of EAD on both graft and recipient outcomes.

Patients and methods: This retrospective study enrolled 360 patients who performed pLT (living-donor liver transplantation (LDLT)=299, deceased-donor liver transplantation (DDLT)=61) between April 2017 and September 2024. The severity of EAD was graded using the Liver Graft Assessment Following Transplantation (L-GrAFT₇) risk score.

Results: The incidence of binary EAD in pLT was 34.2%. The area under the receiver operating characteristic curve of EAD, Model for Early Allograft Function (MEAF) score, and l-GrAFT₇ risk score for predicting graft loss within 90-day post-transplant were 0.84, 0.97, and 0.96 in the LDLT cohort; and 0.79, 0.78, and 0.95 in the DDLT cohort. Significant differences were observed among the low-, moderate-, and high-risk groups in the LDLT cohort regarding ventilator support time, ICU stay time, length of hospitalization, death in hospital, early complications (including hepatic artery thrombosis, portal vein thrombosis, hepatic vein/inferior vena cava stenosis/thrombosis, and biliary complications), and late complications (including hepatic artery thrombosis, portal vein stenosis/thrombosis and hepatic vein/inferior vena cava stenosis). In the DDLT cohort, significant differences were found among the three groups in terms of ICU stay time, death in hospital, early complications (including intra-abdominal bleeding and biliary complications), and late complications (hepatic vein/inferior vena cava stenosis) (p < 0.05). The log-rank test revealed statistically significant differences in graft and recipient survival among the three groups within 90-day, 180-day, and 1-year in both the LDLT and DDLT cohorts (p < 0.05), with this significant difference also observed throughout follow-up period in the DDLT cohort (p < 0.05).

Conclusions: The MEAF score and l-GrAFT₇ risk score effectively predict early graft loss following pLT, with high-risk EAD markedly compromising both short- and long-term graft and recipient outcomes.

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Title: Split and reduced-size liver transplantation in pediatric and adult recipients: single-center outcomes and a left-lateral segment pediatric comparison

Source: Pediatric Transplantation 2026, 30 (5): e70337 

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Date of publication: May 2026  

Publication type: Retrospective, single-centre study

Abstract: Background: Pediatric liver transplant candidates, especially infants, have persistently high waitlist mortality. Deceased-donor technical variant grafts, including split liver transplantation (SLT) or reduced-size liver transplantation (RSLT), could expand access but remain underutilized. Whether splitting compromises the primary recipient’s outcomes is uncertain.

Methods: We conducted a retrospective, single-center study of deceased-donor technical variant liver transplants (2010-2025). Recipients were grouped as pediatric split (P-SLT), pediatric reduced-size (P-RSLT), and adult split (A-SLT). Primary outcomes were 1-year graft and patient survival; secondary outcomes included vascular complications, biliary complications, waitlist time, and waitlist mortality. A prespecified subgroup compared pediatric left lateral segment grafts by technique (split vs. reduced).

Results: Fifty-four patients were included with 14 P-SLT, 26 P-RSLT, and 14 A-SLT cases. Vascular complications were infrequent (1 case each in P-SLT and P-RSLT). Biliary interventions were required during the index hospitalization in 14% (P-SLT), 19% (P-RSLT), and 21% (A-SLT) of recipients. One-year graft survival was 83% (P-SLT), 92% (P-RSLT), and 100% (A-SLT), with patient survival of 92%, 96%, and 100%, respectively. In pediatric LLS recipients, outcomes with split versus reduced grafts showed 1-year graft survival rates of 83% versus 100% (p = 0.333) and patient survival rates of 92% and 100%, respectively (p = 0.619), with no significant differences in complications. Pediatric waitlist during the study period had a mortality rate of 0.21 deaths per 1000 person-days (95% CI 0.04-0.37).

Conclusions: At an experienced center, SLT and RSLT achieved favorable 1-year survival with low vascular morbidity.

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Title: Medication self-management during the developmental transition of responsibility among Chinese adolescent liver transplant recipients: a qualitative descriptive study

Source: European Journal of Pediatrics 2026, 185 (6): 400

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Date of publication: May 2026 

Publication type: Single-center qualitative descriptive study  

Abstract: Adolescence is a high-risk period for non-adherence to immunosuppressive therapy after pediatric liver transplantation, especially as medication responsibility shifts from parent-led routines toward increasing adolescent participation. However, limited evidence explains how adolescents manage medication demands in daily life within school, family, and peer contexts. We conducted a single-center qualitative descriptive study in a tertiary pediatric liver transplant clinic in Southwest China. Using purposive sampling, we recruited adolescents aged 13-17 years who were at least 1 year post-transplant and remained in pediatric follow-up at the time of interview (N = 12). None had transferred to adult services. Semi-structured one-to-one interviews were conducted between July and August 2025, audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Analytic depth was supported through reflexive memoing, post-interview debriefing, preliminary coding during recruitment, dialogic discussion within the research team, and an audit trail. Four interrelated tensions shaped medication self-management during the developmental transition of responsibility: (1) regimen requirements versus school-day routines; (2) growing expectations for autonomy versus uneven readiness for self-management; (3) family and school support that was both enabling and conflict-provoking; and (4) a desire for empowerment and peer normalcy in the context of stigma and limited youth-oriented resources. Participants described overlapping self-management patterns rather than fixed types. In two accounts, episodes of repeated compromise, treatment fatigue, or reduced engagement suggested ongoing vulnerability in particular contexts. Conclusions: Medication non-adherence in adolescence may be shaped by contextual constraints as well as knowledge or motivation. Support should extend beyond standardized education to include individualized medication planning, staged autonomy-building within pediatric follow-up, practical school-day planning, and discreet youth-centered adherence strategies that better fit adolescents’ daily lives.

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Title: What’s new in pediatric metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis

Source: Clinics in Liver Disease 2026, 30 (2): 469-481

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Date of publication: May 2026

Publication type: Review article

Abstract: Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most common chronic liver disease in children, with rising prevalence and substantial systemic consequences. This review synthesizes recent advances in pediatric MASLD and its severe form, metabolic dysfunction-associated steatohepatitis (MASH), with emphasis on new insights in epidemiology, pathogenesis, and disease burden. Diagnostic evaluation in children remains particularly challenging, requiring integration of clinical, laboratory, imaging, and histologic data, while balancing accuracy, feasibility, and risk. Progress will depend on the development of pediatric-specific tools, equitable access to care, and rigorously designed clinical trials to guide future management.

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Title: Outcomes in pediatric recipients of ABO-incompatible liver transplants: an analysis of the SPLIT registry

Source: Liver Transplantation 2026, Apr 30. [E-publication]

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Date of publication: April 2026

Publication type: Article

Abstract: Background: Liver transplantation (LT) is standard of care for children with end-stage liver disease, but waitlist mortality remains high, especially among infants. ABO-incompatible (ABO-I) LT offers a strategy to expand the donor pool, though concerns over antibody-mediated rejection have limited widespread use.

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Title: Autoimmune liver diseases and overlap syndromes in children with inflammatory bowel diseases

Source: European Journal of Pediatrics 2026, 185 (5): 301

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Date of publication: April 2026

Publication type: Review article

Abstract: Autoimmune liver diseases (AILDs)-including autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and autoimmune sclerosing cholangitis (ASC)/AIH-PSC overlap-are clinically relevant extraintestinal manifestations (EIMs) of pediatric inflammatory bowel disease (IBD). This review summarizes current evidence on epidemiology, pathogenesis, diagnosis, management, and outcomes, highlighting key diagnostic challenges and therapeutic limitations. A narrative review of 57 studies, including both adult and pediatric cohorts, published between 1995 and 2026, was conducted. ESPGHAN, NASPGHAN, and AASLD guidelines were also reviewed. Clinical characteristics, imaging and laboratory findings, treatment approaches, and outcomes were synthesized qualitatively. Pediatric IBD-associated AILDs affect 6-7% of children, predominantly those with ulcerative or extensive colitis, and frequently present as overlap phenotypes combining hepatitis and cholangiopathy features. Diagnosis is challenging due to variable liver biochemistry and the limited specificity of enzymes. Gamma-glutamyl transferase (GGT) is the most informative cholestatic marker, while ultrasound and magnetic resonance cholangiopancreatography (MRCP) are complementary imaging modalities; liver biopsy remains essential for overlap phenotypes and fibrosis staging. Immunosuppression effectively controls hepatitis inflammation, whereas no disease-modifying therapy exists for pediatric PSC. Longitudinal monitoring using liver biochemistry, imaging, and risk stratification tools such as the Sclerosing Cholangitis Outcomes in Pediatrics (SCOPE) index for PSC is crucial. Event-free survival in PSC is approximately 70% at 5 years, with 10-30% of children requiring liver transplantation.

Conclusion: Pediatric IBD-associated AILDs represent a heterogeneous and high-risk group of disorders. Multimodal diagnostic strategies and immunosuppressive therapy are central to management; however, effective treatments for PSC remain lacking, highlighting major unmet clinical needs.

What is known: Autoimmune liver diseases (AILDs) are clinically relevant extraintestinal manifestations in pediatric IBD and often present with subtle or asymptomatic biochemical abnormalities. • Hepatic inflammation can be effectively treated with immunosuppression, but there are few treatments for cholangiopathy; long-term monitoring with liver biochemistry, imaging, and biopsy is advised.

What is new: The need for systematic hepatic surveillance even during remission is supported by the possibility that liver disease in pediatric IBD-associated AILDs may advance independently of intestinal activity. • A stepwise approach integrating GGT-based screening, early MRCP, and noninvasive tools (ultrasound and SCOPE index) may improve early detection and risk stratification, although pediatric-specific criteria and disease-modifying therapies remain unmet needs.

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Title: Infectious complications after percutaneous transhepatic biliary drainage in pediatric liver transplant recipients

Source: Pediatric Transplantation 2026, 30 (5): e70328

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Date of publication: May 2026

Publication type: Retrospective review

Abstract: Background: The gold-standard for the diagnosis and management of biliary complications, particularly biliary strictures in pediatric liver transplant (LT) recipients is percutaneous transhepatic cholangiogram (PTC) followed by biliary drainage (PTBD). Despite the established role of PTBD in managing biliary complications in pediatric LT recipients, limited data exist on post-procedural infection rates and optimal antibiotic prophylaxis strategies. The primary aim was to analyze the complications of PTBD in pediatric LT recipients. The secondary aim was to analyze factors associated with PTBD complications.

Methods: We retrospectively reviewed the medical records of children having undergone LT between August 2004 and October 2020 in our center. Patients who developed a biliary complication treated by PTBD were selected. We then compared PTBD patients with complications to those without.

Results: Eleven patients underwent 35 percutaneous transhepatic biliary drainage (PTBD) sessions. Biliary atresia was the most frequent indication for LT in 6/11 (54%) children. Ten (10/11; 91%) received a left lateral segment, and all had undergone biliary-enteric anastomosis. Anastomotic stricture was the most common finding on PTC in 22/35 (63%) sessions. 25/35 (71%) PTBD were conducted using one-day antibiotic prophylaxis and 10/35 (29%) using extended-24-h antibiotherapy. Of 35 PTBD sessions, 17/35 (49%) experienced complications, primarily infectious (40%; 14/35). We compared different antibioprophylaxis regimens in 14 PTBD with infection. There was a trend to a lower incidence of infections in the extended-24-h antibiotherapy group (10%; 1/10) compared to the one-day antibiotic prophylaxis group (52%; 13/25) with a relative risk of 0.19 (0.03-1.28).

Conclusions: PTBD is associated with a high rate of post-procedure infectious complications. These complications result in a high burden and morbidity. There was a trend to an association between extended-24-h antibiotherapy and the absence of infectious complications after PTBD.

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