Liver lesions in Fontan-associated liver disease: current challenges and future directions

The optimal surveillance and diagnostic strategy for hepatic lesions in patients with FALD remains undefined. Multimodal assessment, multidisciplinary care, and a low threshold for biopsy are essential. Liver biopsy remains the only reliable method for characterizing suspicious lesions and staging fibrosis severity in the context of FALD. FALD-specific diagnostic criteria and evidence-based surveillance protocols are urgently needed to guide early detection and improve outcomes.