Prevalence of suspected NAFLD in overweight and obese children determined by two different NAFLD guidelines.Using the combination of elevated ALT and fatty infiltration on ultrasound (European guidelines) increases the detection rate of suspected NAFLD in at risk children. Highlights • Non-alcoholic fatty liver disease might be missed in at-risk children by relying on ALT values alone. • A significant percentage of obese children with fatty infiltration on ultrasound have low ALT values. • Children with fatty infiltration on ultrasound and low ALT values were less likely to have metabolic syndrome.

Pediatric liver transplantation has become very successful with high survival rate. 1 Unlike adult recipients, recurrence of liver disease is unlikely in children. Yet, abnormalities like idiopathic post-transplant hepatitis and graft fibrosis are frequently detected in graft biopsies. Prevalence of fibrosis as high as 43% at 5 years and 64% at 10 years after pediatric liver transplantation has been reported. 2 The gold standard to assess the stage of hepatic fibrosis is liver biopsy. However, it is an invasive procedure and has been associated with

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