Metabolic-(non-alcoholic) associated fatty liver disease (MAFLD/NAFLD) has increasingly become a worldwide epidemic. It has been suggested that renaming NAFLD to MAFLD is critical in identifying patients with advanced fibrosis and poor cardiovascular outcomes. There are concerns that the progression to non-alcoholic steatohepatitis (NASH) may become a constant drive in the future healthcare of children and adolescents. There is a necessity to tackle the emerging risk factors for NASH-associated hepatocellular carcinoma (HCC). In this narrative review, we present the current protocol of liver biopsy separated between pre-analytical, analytical, and post-analytical handling. Genetic association investigations have identified single nucleotide polymorphisms implicated in the progression of MAFLD-HCC, many of which seem to belong to the lipid metabolism pathways. PNPLA3 rs738409 variant, TM6SF2 rs58542926 variant, MBOAT7 rs641738 variant, and GCKR variants seem to be significantly associated with NAFLD disease susceptibility. In disclosing the current comprehensive protocol performed at the Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada, we support the most recent Kulkarni-Sarin’s pledge to rename NAFLD to MAFLD. Grossing of the liver biopsy is key to identifying histologic, immunophenotypical, and ultrastructure data and properly preserving tissue for molecular genomics data.

中文翻译：

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代谢相关脂肪性肝病 (MAFLD) 的肝活检处理：东安大略儿童医院总方案

代谢（非酒精）相关脂肪肝（MAFLD/NAFLD）已日益成为一种全球流行病。有人建议，将 NAFLD 重命名为 MAFLD 对于识别患有晚期纤维化和不良心血管结局的患者至关重要。有人担心，非酒精性脂肪性肝炎 (NASH) 的进展可能会成为儿童和青少年未来医疗保健的持续驱动力。有必要解决 NASH 相关肝细胞癌 (HCC) 的新危险因素。在这篇叙述性综述中，我们介绍了当前的肝活检方案，分为分析前、分析后和分析后处理。遗传关联研究已鉴定出与 MAFLD-HCC 进展有关的单核苷酸多态性，其中许多似乎属于脂质代谢途径。PNPLA3 rs738409 变异、TM6SF2 rs58542926 变异、MBOAT7 rs641738 变异和 GCKR 变异似乎与 NAFLD 疾病易感性显着相关。在披露加拿大安大略省渥太华东安大略儿童医院当前执行的综合方案时，我们支持 Kulkarni-Sarin 最近做出的将 NAFLD 更名为 MAFLD 的承诺。肝活检的大体检查是识别组织学、免疫表型和超微结构数据以及正确保存组织以获得分子基因组学数据的关键。