Resolution of recurrent pediatric acute liver failure with liver transplantation in a patient with NBAS mutation

Hepatic Phenotype in NBAS-Associated Disease: Clinical Course, Prognostic Factors and Outcome in 230 Patients

BACKGROUND AND AIMS

Since described in 2015, NBAS-associated disease has emerged as an important cause of acute liver failure (ALF) in children. We analysed the variable expression, genotype-phenotype association, outcome and prognostic factors of the hepatic involvement.

METHODS

Individuals with biallelic pathogenic NBAS variants were recruited within an international observational study, including new and previously published patients.

RESULTS

We studied 230 individuals, including 13 previously unreported patients. The liver was the most frequently affected organ (63.4%), with 41.3% experiencing at least one ALF. The median age at onset was 0.9 years, the median age at last ALF 5 years, the latest ALF occurred at 24 years. Liver crises were triggered by febrile infections and presented with highly increased hepatic transaminases. Liver involvement varied significantly between the subgroups: 91.7% of patients with infantile liver failure syndrome type 2 and 88.9% of patients from the combined subgroup (variants affecting β-propeller domain) presented with ALF, whereas SOPH (stature, optic atrophy, Pelger-Huët anomaly) patients mostly had either no liver involvement (66.4%) or persistently elevated transaminases without ALF (28%). The rate of native liver survival was 83.9%; 16 individuals underwent liver transplantation and 24 died.

CONCLUSION

Liver abnormalities are common and the leading cause of death in NBAS-associated disease. There is a clear genotype-phenotype association regarding the hepatic involvement. Liver crises occur primarily during infancy; however, early medical attention in case of febrile infections is necessary at all ages. Liver transplantation prevents ALF, but its risks must be weighed against the frequency and severity of liver crises decreasing with age.

Case Report: Living donor liver transplantation for the treatment of recurrent pediatric acute liver failure with neuroblastoma amplified sequence gene mutation: a literature review

Background

Biallelic mutations in the neuroblastoma amplified sequence (NBAS) gene can cause recurrent acute liver failure (RALF) and multi-systemic disease.

Case presentation

Herein, we report a 3-year-old Chinese boy with RALF due to a novel heterozygote mutation c.3596G>A(p.C1199Y)/c.1028G>A(p.S343N) in the NBAS gene, identified by whole-exome sequencing. The missense mutation c.3596G>A(p.C1199Y) was inherited from his father, and c.1028G>A(p.S343N) was inherited from his mother. He had suffered six acute liver crises triggered by fever. He eventually underwent living donor liver transplantation (LDLT) at 44 months, with his father donating the left lateral lobe liver, and is now healthy with no recurrence of ALF.

Conclusion

We describe a novel pathogenic mutation in the NBAS gene of a patient with RALF and report that LDLT is a safe and efficient treatment for RALF caused by the NBAS gene mutation.