Epidemiology

Children with non-alcoholic fatty liver disease at high risk for death and transplant

Last Updated: 2009-11-13 17:56:37 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In children with non-alcoholic fatty liver disease, the risk of dying or needing a liver transplant is nearly 14 times higher than for children of the same age in the general population.

This finding is from a retrospective study by current and former Mayo Clinic researchers, who examined the long-term outcomes and survival of 66 children (mean age, 13.9 years) seen there for non-alcoholic fatty liver disease. The children were followed for a mean of 6.4 years, for a total of 409.6 person-years.

Dr. Paul Angulo, now at the University of Kentucky in Lexington, and colleagues report in the November issue of Gut that 19 children (28.8%) had overt metabolic syndrome when they were diagnosed. Overall, 55 children (83.3%) presented with at least one feature of the metabolic syndrome, including obesity, hypertension, dyslipidemia, and/or hyperglycemia. Four children developed type 2 diabetes 4 to 11 years after their fatty liver disease diagnosis.

Thirteen liver biopsies obtained from five children over an average of 41.4 months showed progression of fibrosis in four cases.

Two patients underwent liver transplantation for decompensated cirrhosis and two others died during follow-up. "The observed number of events in the (fatty liver disease) cohort was significantly higher than the expected number of events in the United States population of same age and sex (4 versus 0.29416, p < 0.00001) with a standardized mortality ratio of 13.6," the authors report.

Non-alcoholic fatty liver disease recurred in both of the children who had liver transplants. One child developed cirrhosis and required re-transplantation.

Gut 2009;58:1538-1544.