*Purpose: Pediatric living donor liver transplant (LDLT) patients sometimes develops graft fibrosis. They showed graft fibrosis even if their liver function tests were within normal range. Therefore we have performed serial protocol biopsies. Recently, the Mac-2 binding protein glycosylation-modified isomer (M2BPGi) was developed as a new marker for progress of hepatic fibrosis, which is a blood test specific to fibrosis. We performed this study to examine the relationship between serum M2BPGi levels and liver histological findings for patients after LDLT.

*Methods: Patients under 19 year old who received LDLT in our institution were gathered. Study was designated for patients who were followed at least 1 years after LDLT. All patients received tacrolimus based our standard immunosuppression. Protocol biopsies were performed yearly basis. 89 patients enrolled in this study. Pathological findings were assessed by the last available biopsy with Hematoxylin-Eosin and Masson trichrome stein. Fibrosis was staged with Metavir score system. Serum M2BPGi level was compared with pathological fibrosis score. Student t-test and Pearson’s chi-square test were used for analysis.

*Results: All patients received LDLT from their relatives. Original diseases were biliary atresia (n=61), metabolic disorders (n=8), fulminant hepatitis (n=7), hepatoblastoma (n=5) and others (n=8). Mean patient age at transplant was 4.6 year olds (ranged 0.2 to 18.9 year olds). Mean observation period was 8.2 years (ranged 1.0 to 20.6 year olds). In the last available biopsies, 14 patients (16%) were no fibrosis (F0). 45 patients (51%) showed F1 fibrosis. 30 patients (33%) developed F2. No patient showed F3 and F4 fibrosis. The M2BPGi value ranged from 0.2 cut-off index (COI) to 9.0 COI (median value, 1.0 COI). Mean M2BPGi was 0.57COI, 0.84COI and 1.49COI in F0, F1 and F2 respectively. Mean M2BPGi in F2 was higher than those in F0 (p=0.004) and F1 (p=0.004) statistically. M2BPGi COIs were graded as negative (COI<1.00), 1+ (COI between 1.00 and 2.00) and 2+ (COI >2.00). Patients F2 were 100% (n=4), 59% (n=17) in grade 2+ and 1+ respectively, whereas only 16% in grade 0. Grade 2+ and 1+ showed moderate fibrosis F2. It was stastically significant ( p<0.0001)

*Conclusions: M2BPGi is a novel fibrosis marker for liver fibrosis in patients after pediatric LDLT. It is especially useful for follow up pediatric LDLT patient to support liver biopsy interpretation. Further follow up is required to determine the relationship between fibrosis progression and M2BPGi.

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