AASLD AST NASPGHAN Practice Guideline on pediatric liver transplantation: Posttransplant management

BACKGROUND AND AIM: Optimizing health and quality of life for pediatric recipients of liver transplant (LT) requires balancing the protection of the liver graft with the overall burden of treatments on the child. Since the American Association for the Study of Liver Diseases (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 on 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 for the comprehensive care of pediatric recipients of LT, starting at transplant and continuing as they advance to adulthood. METHODS: A multidisciplinary writing group of pediatric LT 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 for 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 the best available evidence and reflect expert consensus. Most of the evidence base remains retrospective or observational data, or extrapolation from related populations. To continue improving long-term outcomes after pediatric LT, multidisciplinary, multicenter collaboration to strengthen the evidence will be essential.