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We read with great interest the study conducted by Chen et al. [1]. The authors demonstrated that transient elastography (TE) is a nonpainful, convenient, and safe way to assess the liver injury after Fontan surgery. The data indicated that TE values were higher in Fontan patients versus controls (18.6 versus 4.7 Kpa, P < 0.001 ), although there was no association between TE values and patients age, time since Fontan surgery, or median Fontan circuit pressure. The study design was elegant and the finding was interesting. However, we may wonder whether the liver stiffness among Fontan patients may be biased by alanine aminotransferase (ALT).

Comment on “Assessment of Liver Stiffness in Pediatric Fontan Patients Using Transient Elastography”