Transient Elastography Detects Silent Liver Fibrosis in 38 Percent of Childhood Leukemia Survivors: Study
A recent study published in Indian Pediatrics in April 2026 reveals a surprisingly high prevalence of silent liver fibrosis, affecting over a third (37.9%) of childhood leukemia survivors. These findings highlight transient elastography (TE) as an exceptionally effective, noninvasive screening tool for early clinical detection in post-treatment care.
While routine clinical and biochemical assessments have long been recommended as the standard of care for monitoring long-term hepatobiliary complications in these pediatric patients, there remains a pressing need for highly sensitive, noninvasive diagnostic techniques. To address this specific clinical gap, authors Sanjeev Khera,and colleagues utilized TE to systematically screen for elevated LSM—a reliable biomarker of hepatic fibrosis—and strictly evaluate specific biochemical risk factors in leukemia survivors compared to healthy individuals.
Therefore, the case-control study evaluated 58 childhood acute lymphoblastic leukemia survivors—diagnosed before age 18 and treated between 2016 and 2023—alongside 50 matched controls. At a mean follow-up of 27 months post-therapy, transient elastography (FibroScan) was used to assess liver fibrosis (stiffness ≥5.1 kPa) and hepatic steatosis (attenuation >248 dB/m).
Key Clinical Findings of the Study Include:
Fibrosis Prevalence: Investigators found a significantly higher rate of elevated LSM in cALLs at 37.9% (22 of 58 cases) compared to just 16% (8 of 50) in the healthy control group.
Primary Predictor: Specialists identified a serum alanine transaminase (ALT) level of 40 U/L or greater as the most significant independent predictor for developing high LSM in multivariate analyses.
Steatosis Occurrence: Researchers noted that hepatic steatosis, evaluated via CAP measurements, was distinctly present in nearly one-fifth, or 18.9%, of the examined survivor cohort.
Metabolic Correlations: Analysts demonstrated that hepatic fat measurements positively correlated with key metabolic indicators like serum cholesterol and triglycerides while demonstrating a prominent negative correlation with protective adiponectin levels.
The results suggest that there is a remarkably high prevalence of latent liver fibrosis among survivors of pediatric leukemia, with a substantial portion showing elevated LSM scores of 5.1 kPa or greater. Furthermore, maintaining a strict clinical awareness of ALT levels above 40 U/L is absolutely crucial, as it strongly predicts the rapid development of these late-onset hepatic complications and therefore warrants much closer monitoring.
Thus, the study concludes that integrating TE into routine post-treatment follow-up care protocols could provide practicing clinicians with a highly sensitive, practical, and completely noninvasive method for the early detection and proactive management of hepatobiliary late effects in this highly vulnerable patient population.
Reference
Khera, S., Prasad, A. S., & Kapoor, R. (2026). Liver Fibrosis Screening in Childhood Acute Lymphoblastic Leukemia Survivors by Transient Elastography: A Case-Control Study. Indian Pediatrics, 63, 468–473.
