Hepatopulmonary syndrome as presentation of pediatric metabolic dysfunction‐associated steatohepatitis

Abstract Childhood obesity is rising and leading to serious co‐morbidities, among which is metabolic dysfunction‐associated steatotic liver disease (MASLD) predisposing individuals to cirrhosis. We describe a young 11‐year‐old Hispanic male who presented with hepatopulmonary syndrome secondary to cirrhotic portal hypertension from metabolic dysfunction‐associated steatohepatitis (MASH), necessitating liver transplantation. Despite lifestyle modifications post‐transplantation, the patient experienced persistent weight gain and recurrence of steatosis, emphasizing challenges of managing pediatric MASLD. The burden of childhood obesity is increasing and impacting children significantly earlier than previously believed. Our case is one of the few to report the severe complications of MASH in a young, pre‐teen child necessitating early liver transplantation. Furthermore, the case highlights the evolving landscape of pediatric liver transplant, with MASH increasingly recognized as an indication for pediatric liver transplantation. The management of this disease is challenging and requires a multidisciplinary approach.