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NAFLD and Liver Transplantation in Children—Working Group Report From the ILTS Single Topic Conference on NAFLD

Cananzi, Mara, MD1; Vajro, Pietro, MD2; Rela, Mohamed, FRCS3; Dhawan, Anil, MD4

doi: 10.1097/TP.0000000000002490

Background Nonalcoholic fatty liver disease (NAFLD) has now become a common cause of chronic liver disease in children; however, unlike adults liver transplantation is rarely required as treatment. It is important that in children presenting with NAFLD, secondary causes of fatty liver particularly inherited metabolic defects should be excluded.

Methods A pediatric working group comprised of 3 hepatologists and a liver transplant surgeon was tasked with a set of questions to address the current state of evidence and knowledge about NAFLD in children with particular focus on liver transplantation. A systematic review of the English literature regarding pediatric NAFLD (from birth to 18 years of age) published in the last 2 decades (2000-2018) was carried out. The evidence was evaluated by the subgroup members and further discussed with the wider workshop faculty leading to the recommendations for best practice.

Results Given the paucity of literature on the subject good quality of evidence was only available on risk factors for NAFLD and medical treatment where the group could make recommendation with high/moderate strength. The evidence on natural history and indications for liver transplantation was poor hence group could not make any recommendations.

Conclusions Based on the existing literature and subgroups, collective experience NAFLD unlike in adults is a very rare indication for liver transplantation in children. No definitive recommendations could be made about the natural history, indications, and outcome of liver transplantation for NAFLD in children.

1 Unit of Paediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, University Hospital of Padova, Padova, Italy.

2 Pediatrics, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.

3 Dr Rela Institute and Health Center, Chennai, India.

4 Paediatric Liver GI and Nutrition Center, King's College Hospital, London, United Kingdom.

Received 29 July 2018. Revision received 30 September 2018.

Accepted 5 October 2018.

The authors declare no funding or conflicts of interest.

All authors revised the literature. C.M. and V.P. wrote the first draft of the article. D.A. provided the first revision of the article. All the authors revised the article critically and gave final approval for submission.

Correspondence: Anil Dhawan, MD, Paediatric Liver GI and Nutrition Center, King's College Hospital, London, United Kingdom. (

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