Significance of progressive liver fibrosis in pediatric liver transplants: A review of current evidence

doi:10.3748/wjg.v26.i17.1987

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. May 7, 2020; 26(17): 1987-1992
Published online May 7, 2020. doi: 10.3748/wjg.v26.i17.1987

Significance of progressive liver fibrosis in pediatric liver transplants: A review of current evidence

Mathew George, Philippe Paci, Timucin Taner

Mathew George, Philippe Paci, Timucin Taner, Departments of Surgery, Mayo Clinic, Rochester, MN 55905, United States

Timucin Taner, Departments of Immunology, Mayo Clinic, Rochester, MN 55905, United States

Author contributions: George M, Paci P and Taner T conceived and outlined the review; George M and Paci P performed literature review and wrote the manuscript; Taner T made critical revisions and approved the final version of the manuscript.

Conflict-of-interest statement: The authors declare no conflict of interests.

Corresponding author: Timucin Taner, FACS, MD, PhD, Associate Professor, Surgeon, Departments of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, United States. taner.timucin@mayo.edu

Received: December 31, 2019
Peer-review started: December 31, 2019
First decision: February 19, 2020
Revised: March 31, 2020
Accepted: April 21, 2020
Article in press: April 21, 2020
Published online: May 7, 2020
Processing time: 127 Days and 14.9 Hours

Abstract

This article reviews the current evidence and knowledge of progressive liver fibrosis after pediatric liver transplantation. This often-silent histologic finding is common in long-term survivors and may lead to allograft dysfunction in advanced stages. Surveillance through protocolized liver allograft biopsy remains the gold standard for diagnosis, and recent evidence suggests that chronic inflammation precedes fibrosis.

Keywords: Allograft fibrosis; Pediatric liver transplant; Chronic rejection; Immunosuppression; Portal inflammation; Liver allograft

Core tip: Progressive liver allograft fibrosis is a common finding after liver transplantation in children and may lead to allograft failure in the long-term. Recent data from centers performing sequential protocol biopsies after pediatric liver transplantation demonstrate that chronic inflammation precedes fibrosis. In this review, we provide an update on pathogenesis, diagnosis and management of progressive liver fibrosis in pediatric liver transplant recipients.