Pediatric Liver Diseases

Progress in recognizing and treating pediatric liver diseases has accelerated remarkably in the past decade. In part, this is attributable to newly available translational technologies, advances in the fields of genomics and immunology, innovations in stem cell biology, and expanding opportunities in organizing and financing multicenter clinical trials. In the United States, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has funded several clinical consortia focusing on pediatric liver diseases, such as the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN), the Cholestatic Liver Disease Research and Education Network (ChiLDREN), the Pediatric Acute Liver Failure Network (PALFSG), and the Drug-Induced Liver Injury Network (DILIN). These networks have provided the patient volume and mix, perspective, talent, and finances needed to address significant problems in pediatric hepatology. The organization made possible by our professional societies further accelerates progress.

This issue of Seminars in Liver Disease, dedicated to topics in pediatric liver diseases, represents the sixth time that the journal has focused its attention on this topic. The last issue on pediatric liver diseases in this journal was published 5 years ago, with Dr. Ronald Sokol as Guest Editor. In this current issue, exceptionally talented leaders in pediatric hepatology were recruited to address some liver problems unique to children (biliary atresia, congenital portosystemic shunting, gestational alloimmune liver disease, and intestinal failure associated with liver disease in children) and others representing problems overlapping with adult conditions (nonalcoholic fatty liver disease, portal hypertension) to delineate differences in approach or management. A further review contributed by Ordonez and Goldstein describes the use of pluripotent stem cells to model monogenic diseases of the liver, permitting understanding of the 200 or more human monogenic diseases of the liver in a model that accurately and perpetually represents the human condition.

The last time I served as Guest Editor for Seminars on the issue of pediatric liver diseases was 18 years ago. The progress made in understanding pathogenesis and treatment since then has been astounding. I can't wait for the next edition 18 years hence.