Evaluating the role and effectiveness of protocol liver biopsies in pediatric post-transplant care: a…

ReviewScandinavian journal of gastroenterology· Jun 2026

Evaluating the role and effectiveness of protocol liver biopsies in pediatric post-transplant care: a systematic review.

Eyad Gadour, Razan Bader, Ahmed Zaidan … Mohammed Saad AlQahtani

Gastrointestinal & Liver PathologyReviewClinical practiceQ2IF 1.8

Protocol biopsies found fibrosis in most pediatric liver transplant recipients by 15 years

Evaluating the role and effectiveness of protocol liver biopsies in pediatric post-transplant care: a systematic review.

Eyad Gadour … Mohammed Saad AlQahtani

Scandinavian journal of gastroenterology · Jun 2026

Background

Pediatric liver transplantation has improved long-term survival, but optimal surveillance strategies for late graft injury remain uncertain.

Purpose

This systematic review evaluated the utility of protocol liver biopsies for detecting subclinical histopathological abnormalities after pediatric liver transplantation, particularly fibrosis, inflammation, steatosis, and rejection.

Methods

We conducted a PRISMA-compliant systematic review of PubMed and ScienceDirect, with supplementary hand-searching of references and trial registries.

n = 2004 pediatric liver transplant

Results

fibrosis becomes the norm by 15 years post-transplant

1 year

66.2%

15 years

81.6%

More results

Protocol biopsies frequently identified histological abnormalities despite minimal or absent clinical symptoms.

Inflammation was also prevalent but tended to decline over time.

In comparative data, protocol biopsies detected more subclinical rejection than for-cause biopsies in stable recipients.

“

Conclusion · 1 of 2

In selected cases, repeat protocol or targeted follow-up biopsies after treatment modification may help determine whether inflammation or fibrosis is stabilizing, improving, or progressing.

Conclusion · 2 of 2

Protocol liver biopsies are a valuable surveillance tool in pediatric liver transplant follow-up, enabling early detection of clinically silent graft pathology and potentially informing timely immunosuppression adjustment.

Evaluating the role and effectiveness of protocol liver biopsies in pediatric post-transplant care: a systematic review.

Evaluating the role and effectiveness of protocol liver biopsies in pediatric post-transplant care: a systematic review.

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