Steatotic liver disease after paediatric liver transplantation

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-centre study of paediatric liver-transplanted patients (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 post-transplantation, 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 paediatric 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.