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World J Hepatol. Nov 27, 2021; 13(11): 1727-1742
Published online Nov 27, 2021. doi: 10.4254/wjh.v13.i11.1727
Cystic fibrosis associated liver disease in children
Joseph J Valamparampil, Girish L Gupte
Joseph J Valamparampil, Girish L Gupte, Liver Unit, Birmingham Children’s Hospital, Birmingham B4 6NH, United Kingdom
Author contributions: Gupte GL contributed to the conceptualization and intellectual input of final draft of manuscript; Valamparmpil JJ contributed to primary draft of manuscript, data collection and literature retrieval; and both authors contributed equally to the manuscript.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Girish L Gupte, MD, Consultant Physician-Scientist, Liver Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom. girishgupte@nhs.net
Received: June 11, 2021
Peer-review started: June 11, 2021
First decision: July 6, 2021
Revised: July 19, 2021
Accepted: September 16, 2021
Article in press: September 16, 2021
Published online: November 27, 2021
Processing time: 166 Days and 0.8 Hours
Abstract

Cystic fibrosis (CF) is an autosomal recessive disorder caused by mutations in the CF transmembrane conductance regulator gene. CF liver disease develops in 5%-10% of patients with CF and is the third leading cause of death among patients with CF after pulmonary disease or lung transplant complications. We review the pathogenesis, clinical presentations, complications, diagnostic evaluation, effect of medical therapies especially CF transmembrane conductance regulator modulators and liver transplantation in CF associated liver disease.

Keywords: Cystic fibrosis liver disease; Portal hypertension; Cirrhosis; Liver transplantation; Cystic fibrosis transmembrane conductance regulator modulators; Distal intestinal obstructive syndrome

Core Tip: Cystic fibrosis(CF) liver disease is caused by abnormal cholangiocyte function, altered biliary secretion and abnormal innate immune response with abnormal response to endotoxins. CF liver disease can present with a wide variety of clinical features from a heterogenous liver on ultrasound, to life threatening gastrointestinal bleeds secondary to portal hypertension. Novel treatment strategies directly targeting the ion channel abnormality-cystic fibrosis transmembrane conductance regulator modulators are available and has significantly improved the clinical status and life expectancy of the cystic fibrosis patients.