Advanced Diagnostic and Treatment Approach in Pediatric Hepatology

A special issue of Pediatric Reports (ISSN 2036-7503).

Deadline for manuscript submissions: 30 September 2026 | Viewed by 1020

Special Issue Editor


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Guest Editor
1. 2nd Pediatric Discipline, Department of Mother and Child, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
2. 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
Interests: pediatrics; hepatology; gastroenterology; nutrition; metabolic diseases; immunology; non-invasive evaluation methods; e-learning; social pediatrics

Special Issue Information

Dear Colleagues,

Contemporary pediatric hepatology has reached a crucial turning point, driven by significant advances in diagnostic tools and treatment options. This Special Issue covers the full range of pediatric liver diseases, reflecting the changing practice of clinical care.

Advanced diagnostics have revolutionized clinical management across various disease entities. Non-invasive imaging techniques, including ultrasound and magnetic resonance elastography, now enable accurate assessment of fibrosis without procedural risk. Next-generation sequencing has transformed the identification of inherited cholestatic liver diseases, enabling rapid genetic diagnosis. Advanced serological and immunologic profiling has changed disease stratification in autoimmune hepatitis, allowing for mechanistically informed treatment choices. A better understanding of the gut–liver axis clarifies the bidirectional relationship between inflammatory bowel disease and autoimmune hepatobiliary disorders.

The therapeutic paradigm has shifted toward mechanistically informed, disease-modifying treatments, improving the outcomes across pediatric hepatology. Bile acid transporter inhibitors have revolutionized the management of genetic cholestasis, potentially delaying or preventing the need for transplantation. In autoimmune hepatitis, novel immunosuppressive agents have expanded treatment options. Direct-acting antivirals continue to advance in pediatric viral hepatitis management, while a better understanding of gut–liver interactions informs integrated management of IBD-associated hepatobiliary disease.​

Liver transplantation remains the definitive treatment for end-stage liver disease and certain metabolic disorders, with significantly improved outcomes. Modern strategies, including living donor transplantation, advanced immunosuppressive therapies, and improved long-term follow-up, have resulted in 20-year patient survival rates exceeding 95%.

This Special Issue aims to include contributions that focus on diagnostic innovation, therapeutic progress, and transplantation outcomes throughout the entire spectrum of pediatric liver disease. These articles showcase the field's development toward mechanistically driven, genotype-guided, and outcome-centered care, which aligns with current principles of pediatric hepatology practice. We believe this collection will become a key resource for clinicians, researchers, and trainees involved in pediatric liver disease management and will drive further progress in this quickly advancing field.

Dr. Tudor Lucian Pop
Guest Editor

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Keywords

  • pediatric hepatology
  • autoimmune liver diseases
  • genetic cholestasis
  • chronic viral hepatitis
  • acute liver failure
  • rare diseases
  • next-generation sequencing
  • non-invasive imaging
  • direct-acting antivirals
  • bile acid transporter inhibitors
  • disease-modifying therapy
  • liver transplantation

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Published Papers (1 paper)

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12 pages, 2811 KB  
Case Report
Pediatric Autoimmune Sclerosing Cholangitis: Diagnostic and Therapeutic Challenges
by Raisa-Maria Sucaciu, Alina Grama, Alexandra Mititelu, Bianca Raluca Mariș, Ioana Filimon, Bobe Petrushev, Daniel Cristian Popescu, Gabriel Benţa and Tudor Lucian Pop
Pediatr. Rep. 2026, 18(2), 54; https://doi.org/10.3390/pediatric18020054 - 8 Apr 2026
Cited by 1 | Viewed by 693
Abstract
Background. Autoimmune sclerosing cholangitis (ASC) is a rare clinical entity characterized by overlapping features of autoimmune hepatitis and primary sclerosing cholangitis. It predominantly affects pediatric patients. Therapeutic management is often complex, requiring a multidisciplinary and individualized approach, especially in the context of associated [...] Read more.
Background. Autoimmune sclerosing cholangitis (ASC) is a rare clinical entity characterized by overlapping features of autoimmune hepatitis and primary sclerosing cholangitis. It predominantly affects pediatric patients. Therapeutic management is often complex, requiring a multidisciplinary and individualized approach, especially in the context of associated autoimmune diseases. Case presentation. We present the case of a female patient diagnosed at the age of 10 with ASC, for which immunosuppressive therapy with prednisone, azathioprine (AZA), and ursodeoxycholic acid (UDCA) was initiated, with an initially favorable course. One year later, following a Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, the patient experienced reactivation of liver disease and subsequently developed ulcerative pancolitis (UC), for which 5-aminosalicylic acid (5-ASA) therapy was initiated. Due to repeated hepatic flares and/or colitis relapses, therapy was escalated successively to mycophenolate mofetil, tacrolimus, and eventually infliximab (IFX). Despite treatment, the liver disease progressed, culminating in liver cirrhosis. Our patient developed portal hypertension and esophageal varices, with two episodes of upper gastrointestinal bleeding requiring endoscopic band ligation. At the age of 14, the patient developed recurrent episodes of non-infectious ulcerative stomatitis. Biopsy of the lesions revealed non-specific chronic inflammation, unrelated to colitis activity (confirmed microscopic remission of UC). By exclusion, an adverse drug reaction was suspected, with AZA being the most likely cause. Following its discontinuation, the lesions resolved. Beyond the physiological and therapeutic aspects, the patient displays marked emotional fragility due to prolonged and repeated hospitalizations (18 out of 60 months), which have impacted treatment adherence. Conclusions. This case highlights the complexity of managing pediatric patients with multiple autoimmune diseases. The necessary combination of immunosuppressive therapies may lead to significant adverse effects and further complicate disease progression. Moreover, psychological components play a crucial role in treatment compliance and therapeutic success, emphasizing the need for an integrated approach that includes specialized psychological support. Full article
(This article belongs to the Special Issue Advanced Diagnostic and Treatment Approach in Pediatric Hepatology)
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