Long-Term Medical Management of the Pediatric Patient After Liver Transplantation
Publication Date: February 1, 2014
Last Updated: March 14, 2022
Recommendations
ROUTINE MONITORING AND MANAGEMENT
Growth and Nutritional Rehabilitation
Optimize the nutritional status before and after LT. (1 – StrongB)
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To encourage growth, routine immunosuppression protocols should minimize steroid exposure during the first 6 to 12 months after transplantation. (1 – StrongA)
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Measure the height and weight to identify patients with growth impairment who may benefit from reduced steroid exposure. (1 – StrongB)
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Monitor the body mass index and consider obesity management. (2 – WeakC)
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Endocrine and Bone Metabolism
Monitor patients for persistent hepatic osteodystrophy, risk factors for fractures, and scoliosis. (1 – StrongB)
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Continue mineral and fat-soluble vitamin supplementation (especially D2, or D3) until vitamin D levels are normal. (1 – StrongB)
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Psychosocial Development
The follow-up of school-aged LT recipients should include an assessment of school functioning and school absence. ( 1 – Strong , A)
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Be aware of posttraumatic stress disorder or other mental health issues and refer a patient for a formal psychiatric evaluation if significant symptoms are present. (1 – StrongB)
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Neurocognitive Function
Screen neurocognitive function before transplantation for LT candidates older than 5 years and at key junctures afterward to determine special education needs. (1 – StrongB)
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Assess recipients for hearing loss in the first postoperative year and periodically thereafter as indicated. (1 – StrongB)
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Provide rehabilitation immediately after transplantation: physical therapy for infants with delayed motor development and speech and occupational therapy for older children with deficits. (1 – StrongB)
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Adherence
The transplant team assesses and treats nonadherence with a multidisciplinary approach. (2 – WeakB)
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Screen for nonadherence with objective methods such as the monitoring of immunosuppressant levels. (1 – StrongB)
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Screening and Detection of Late Surgical Complications
Surgical complications are optimally investigated and treated at a transplant center. (2 – WeakB)
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Protocol Liver Biopsy
Protocol liver biopsy 1 year after transplantation is not required. ( 1 – Strong , B)
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Screening for Skin Cancer
Encourage protective clothing, regular screening for skin lesions, and sunscreen. (1 – StrongB)
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Safe Living
Minimize infection risks related to hygiene, food, water, animals/pets, and travel. (2 – WeakC)
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Recipients can travel abroad 6 months after transplantation with normal precautions and the advice of their transplant center. (2 – WeakC)
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Combat childhood infections with recombinant or killed vaccines. (1 – StrongA)
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Immunize household contacts. Recipients and relatives should receive the annual influenza immunization. (1 – StrongB)
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Overview
Title
Long-Term Medical Management of the Pediatric Patient After Liver Transplantation
Authoring Organization
American Association for the Study of Liver Diseases