The evolving landscape of pediatric hepatology: key updates and future directions.

Purpose of review: To provide an update of recent advancements in pediatric hepatology, highlighting new diagnostic criteria, emerging therapeutic options, and molecular insights into liver diseases which are reshaping clinical practice and guiding future research.

Recent findings: Nonalcoholic fatty liver disease (NAFLD) has been redefned as metabolic dysfunction-associated steatotic liver disease (MASLD), reflecting an improved understanding of its underlying pathophysiology. Advances in immunophenotyping have identified activated T-cell hepatitis as a significant contributor to indeterminate pediatric acute liver failure. Additionally, the introduction of ileal bile acid transporter (IBAT) inhibitors marks a transformative shift in the management of pediatric cholestatic diseases including Alagille syndrome and progressive familial intrahepatic cholestasis (PFIC), offering improved growth, quality of life, and native liver survival.

Summary: Recent developments in pediatric hepatology are changing how liver diseases are approached in clinical practice. Evolving disease classifications, expanded use of genetic and immunologic profiling, and the introduction of novel therapies mark a shift toward more individualized care. Ongoing research is needed to evaluate long-term outcomes and ensure that these advances translate into durable improvements for children with liver disease.