Liver disease in Pediatric populations: A growing challenge

An estimated 3 to 5% of all chronic liver disease cases worldwide occur in children under 18, and this proportion has been creeping upward over the past two decades [1]. Pediatric liver disease encompasses a broad spectrum, from neonatal cholestatic conditions like biliary atresia to adolescent-onset metabolic disorders such as non-alcoholic fatty liver disease (NAFLD), each carrying distinct diagnostic and therapeutic challenges. Despite growing recognition that early identification improves long-term outcomes, many affected children still face delayed diagnosis, limited access to specialist care, and a shortage of age-appropriate therapeutic options. This research examined the clinical and epidemiological profile of pediatric liver disease at a tertiary referral centre in Toronto, Canada, over a five-year retrospective period from January 2017 through December 2021. Medical records of 834 children aged 0 to 17 years who received a confirmed liver disease diagnosis during this window were reviewed. Demographic data, presenting symptoms, laboratory findings, imaging results, histopathological reports, and treatment outcomes were extracted and analysed. Biliary atresia constituted the largest diagnostic category at 28.3% of cases, followed by NAFLD at 22.7%, autoimmune hepatitis at 14.1%, Wilson disease at 9.6%, and alpha-1 antitrypsin deficiency at 8.4%. Viral hepatitis accounted for 7.2%, drug-induced liver injury for 5.8%, and miscellaneous aetiologies for the remaining 3.9%. Age distribution analysis revealed distinct patterns: biliary atresia dominated in infants under one year, whereas NAFLD and autoimmune hepatitis were concentrated in the 10-to-18 age bracket. The median time from symptom onset to confirmed diagnosis was 4.7 months overall but varied dramatically by condition—just 1.3 months for biliary atresia, which typically presents with neonatal jaundice, compared with 8.9 months for Wilson disease, where symptoms are often subtle and nonspecific. Among the 834 patients, 127 (15.2%) eventually required liver transplant evaluation, and 68 (8.2%) underwent transplantation during the observation period. Five-year graft survival stood at 89.7% for transplant recipients, which is consistent with published North American benchmarks. Importantly, 43.1% of NAFLD patients had at least one metabolic comorbidity at diagnosis, most commonly obesity (37.8%) followed by insulin resistance (28.4%) and dyslipidaemia (19.3%). These metabolic associations underscore the need for integrated management strategies that address liver health alongside broader cardiometabolic risk. The findings highlight an evolving landscape of pediatric hepatology in Canada, where metabolic liver disease is rising while infectious causes decline. Early referral pathways, standardised diagnostic protocols, and multidisciplinary care models appear essential to improving outcomes across this heterogeneous patient population.

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