Dig Liver Dis. 2025 Oct 28:S1590-8658(25)01144-2. doi: 10.1016/j.dld.2025.09.031. Online ahead of print.
ABSTRACT
BACKGROUND: The progression of allograft fibrosis and its causes after pediatric liver transplantation (PedLT) remain under investigation.
METHODS: This study evaluated long-term graft fibrosis progression and its associated risk factors in 137 liver grafts in 133 patients who survived at least one-year post-transplantation.
RESULTS: A total of 517 protocol liver biopsies (PLBs) scored using the METAVIR system were performed at 1, 5, 10-, 15-, 25-, and 30-years post-LT. The mean fibrosis progression over time was 0.82 ± 0.7, 1.12 ± 0.76, 1.44 ± 0.88, 1.59 ± 1.01, 1.50 ± 0.86, 1.46 ± 0.9, and 1.88 ± 1.16, respectively. In multivariate analysis, significant fibrosis (≥F2) was associated with biliary stenosis (HR 2.07 [1.14-3.75], p = 0.017), while induction therapy was protective against severe fibrosis (≥F3) (HR 0.24 [0.07-0.76], p = 0.015). Among 114 patients tested for de novo donor-specific antibodies (dnDSAs), 42.9 % developed class II DSAs after an average of 12.4 ± 6.6 years. DSA-positive recipients were more likely to have undergone LT for acute liver failure, had less induction therapy, more fibrosis progression, chronic rejection, and worse graft survival.
CONCLUSIONS: Progressive fibrosis remains the leading cause of graft loss in PedLT. However, its progression was slow over three decades. PLBs are useful for identifying patients at risk of graft loss and adjusting immunosuppression to reduce the development of dnDSAs and the progression of chronic injury.
PMID:41162295 | DOI:10.1016/j.dld.2025.09.031
