AASLD AST NASPGHAN Practice Guideline on pediatric liver transplantation: Post-transplant management
Emily R. Perito, Justin K. Chen, Lara A. Danziger-Isakov, Moreshwar S. Desai, Rima Fawaz, Amy G. Feldman, Christine K. Lee, John C. Magee, Blayne A. Sayed, Eyal Shemesh, Pamela L. Valentino, Jennifer Vittorio, Simon P. HorslenBackground and Aim:
Optimizing health and quality of life for pediatric liver transplant (LT) recipients requires balancing protection of the liver graft with overall burden of treatments on the child. Since the AASLD’s 2013 guidelines, strategies for achieving this balance have evolved, with a particular focus on mitigating long-term complications. Advances include operative and intensive care strategies for reducing complications, minimizing exposure to immunosuppression and its long-term adverse effects for other organs, infection prevention with prophylaxis and vaccination, optimizing support of early nutrition and development, and improving support around transition from pediatric to adult care. This document aims to provide an evidence-based guideline to comprehensive care of pediatric LT recipients, starting at transplant and continuing as they advance to adulthood.
Methods:
A multidisciplinary writing group of pediatric liver transplant experts and a medical librarian was convened by AASLD, with guidance by its Practice Guidelines Development Policy, and in collaboration with the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the American Society of Transplantation (AST). We conducted a systematic global literature review, formulated key clinical questions, and developed recommendations. Each recommendation was graded using the Oxford Centre for Evidence-Based Medicine framework and categorized by strength through a consensus voting process.
Conclusion:
All recommendations are based on best-available evidence and reflect expert consensus. Most of the evidence basis remains retrospective or observational data, or extrapolation from related populations. To continue improving long-term outcomes after pediatric liver transplant, multi-disciplinary, multi-center collaboration to strengthen the evidence will be essential.