Treatment of rapid recurrence of severe steatosis with combined glucagon-like peptide-1 agonist and growth hormone therapy in a pediatric patient transplanted for metabolic dysfunction-associated steatohepatitis cirrhosis in the setting of hypopituitarism.

The association between hypopituitarism and metabolic dysfunction-associated steatotic liver disease is increasingly recognized, although data about therapies targeting recurrence posttransplant is limited. An 8-year-old with hypopituitarism-associated metabolic dysfunction-associated steatotic liver disease underwent a liver transplant due to rapid progression of metabolic dysfunction-associated steatohepatitis. Hepatosteatosis recurred within weeks. Her therapeutic plan included a glucagon-like peptide-1 agonist and growth hormone replacement. Her transaminases normalized in 2.5 months, and her macrosteatosis significantly improved on the 1-year surveillance biopsy. This case highlights one of the youngest reported children with hypopituitarism to have undergone transplantation for rapidly progressing metabolic dysfunction-associated steatohepatitis and its recurrence post-operatively. We observed that steatosis improved with growth hormone replacement and glucagon-like peptide-1 agonist therapy. If started early, this combination could help delay recurrence of steatosis post-transplantation. Further research is needed to determine long-term effects and establish protocols.