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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical, pathological characteristics and long-term outcomes of hepatitis B virus related cirrhosis in pediatric observational study
Bo-Kang Zhao, Yan Li, Yi-Yun Jiang, Mei-Ling Li, Yue Jiang, Li Zhu, Chao-Nan Guo, Shu-Hong Liu, Lin Chen, Li-Na Jiang, Jun-Qi Niu, Jing-Min Zhao
Bo-Kang Zhao, Jun-Qi Niu, Center of Infectious Diseases and Pathogen Biology, Department of Hepatology, The First Hospital of Jilin University, Changchun 130061, Jilin Province, China
Yan Li, Yi-Yun Jiang, Mei-Ling Li, Li Zhu, Chao-Nan Guo, Shu-Hong Liu, Li-Na Jiang, Jing-Min Zhao, Department of Pathology and Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Yue Jiang, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
Lin Chen, Department of Pathology and Hepatology, The Fifth Medical Center of PLA General Hospital, Chinese People’s Liberation Army (PLA) Medical School, Beijing 100039, China
Co-corresponding authors: Li-Na Jiang and Jing-Min Zhao.
Author contributions: Zhao BK contributed to literature search and writing of the manuscript; Li Y, Jiang YY and Li ML contributed to data collection; Jiang Y contributed to data analysis; Zhu L, Guo CN, and Liu SH contributed to pathological analysis; Chen L, Jiang LN, and Niu JQ contributed to study design, analysis and interpretation of data; Chen L and Niu JQ are co-senior authors, they played pivotal roles in the conception, design, and execution of the research; Zhao JM contributed to study concept and design, funding support, critical revision of the article and final approval of the version to be published; Jiang LN and Zhao JM contributed equally to this manuscript and are co-corresponding authors. All the authors have read and approved the final revision to be published.
Supported by National Key R&D Program of China, No. 2023YFC2308104; Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support, No. ZLRK202301; and National Natural Science Foundation of China, No. 92159305.
Institutional review board statement: The present study was approved by the Fifth Medical Center of PLA General Hospital (Approval No. KY-2024-4-58-1).
Informed consent statement: Informed written consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: If you need the data, please contact the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jing-Min Zhao, MD, PhD, Professor, Department of Pathology and Hepatology, The Fifth Medical Center of PLA General Hospital, No. 100 Xisihuan Middle Road, Fengtai District, Beijing 100039, China.
jmzhao302@163.com
Received: September 11, 2025
Revised: October 12, 2025
Accepted: November 10, 2025
Published online: December 28, 2025
Processing time: 107 Days and 19.9 Hours
BACKGROUND
Chronic hepatitis B virus (HBV) infection acquired in childhood frequently presents with mild or nonspecific symptoms, yet a distinct subset of pediatric patients develops rapid progression to liver cirrhosis (LC) before adulthood.
AIM
To identify clinical and pathological characteristics of pediatric HBV-related LC.
METHODS
A total of 1332 pediatric patients with chronic HBV infection from the Fifth Medical Center of PLA General Hospital from January 2010 to January 2023 were included in this study. We identified 62 pediatric HBV-related LC by liver biopsy from the group. Subsequently, we described the clinical and pathological characteristics of pediatric LC. And 64 pediatric chronic hepatitis B (CHB; age and sex were matched with pediatric LC group) and 69 adult HBV-related LC (sex were matched with pediatric LC group) were enrolled to further demonstrate clinical and pathological differences between pediatric LC, pediatric CHB and adult LC.
RESULTS
We enrolled 62 pediatric LC, including 54 (87.1%) males and 8 (12.9%) females. The median age was 11 (4-14) years old. The pediatric LC group showed significantly lower median quantitative HBV DNA loads (log10IU/mL: 6.3 vs 17.4, P < 0.001), reduced HBsAg titers (log10IU/mL: 3.11 vs 8.956, P < 0.0001), and diminished hepatitis B e antigen-positive positive rate (81.4% vs 93.8%, P < 0.05) compared with pediatric CHB. A higher proportion of pediatric patients were asymptomatic (77.4%) compared to adult patients (11.6%) as they first diagnosed as LC, pediatric LC showed milder initial symptoms compared with adult patients such as fatigue (4.8% vs 27.5%), abdominal discomfort (9.7% vs 23.2%), nausea (0% vs 10.1%), and poor appetite (6.5% vs 8.7%; all P < 0.0001). Notably, pediatric LC can achieve a significant percentage of functional cure compared with adult LC as 17.4% and 0%. The incidence of progression of LC in children after antiviral therapy continues to be much lower than that in adult LC (hazard ratio = 6.102, 95% confidence interval: 1.72-21.65, P = 0.00051). While the incidence of LC remission in children after antiviral therapy continues to be much higher than that in adult LC (hazard ratio = 0.055, 95% confidence interval: 0.07128-0.2802, P < 0.0001).
CONCLUSION
Pediatric patients with HBV-related cirrhosis exhibit elevated virological parameters and heightened transaminase levels than adult patients. However, the frequent paucity of overt clinical symptoms contributes to diagnostic challenges. Notably, early initiation of antiviral therapy in this population substantially improved clinical outcomes.
Core Tip: Pediatric cirrhosis is mostly detected via physical examination with rare symptoms, whereas adults typically present with jaundice, hematochezia, and fatigue. Pediatric cirrhosis has a better prognosis than adult cases, with higher hepatitis B surface antigen seroclearance rates and potential rapid reversal in some instances, while adult cirrhosis generally carries a poor prognosis. Pediatric cirrhosis progresses more rapidly (even occurring in children < 3 years old), whereas adult cases follow a slower clinical course. Children with cirrhosis often have a history of liver dysfunction and frequently experience disease recurrence due to self-discontinuation of hepatoprotective/antiviral/traditional Chinese medicine treatments.
