Public Comment Form for the AASLD Guideline on Pediatric Liver Transplantation: Post-Transplant Management

AASLD welcomes stakeholders to review guideline statements for the guideline on Pediatric Liver Transplantation: Post-Transplant Management. By beginning this survey, you confirm that you understand these guideline statements are not yet considered final and should not be used in practice or for education until final statements are published in a peer-review medical journal. Feedback received during the open comment period is considered advisory and will be reviewed by the writing group. AASLD will not respond to reviewers. The public comment period is open through April 20, 2026.

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Question 1: What strategies can be used to accelerate a pediatric liver transplant recipient’s recovery and protect the liver graft, immediately after transplant in the intensive care unit?

Respiratory support
1. Pediatric liver transplant recipients should be extubated early (immediately or within 24 hours) after liver transplant whenever feasible. (Level 3; Strong)

2. Strategies to promote early extubation should be implemented at all pediatric liver transplant programs. (Level 3; Strong)

Cardiovascular support
3. Hypovolemia and hypotension should be avoided to preserve graft flow and prevent extra-hepatic organ injury. (Level 4; Strong)

4. Shock should be treated following established, goal-directed pediatric shock guidelines. (Level 4; Strong)

5. Persistent systemic hypertension should be avoided in the postoperative period. (Level 4, Strong)

6. Hypertension should be treated with calcium channel blockers as a first line agent. (Level 4, Strong)

Sedation and Analgesia
7. Fentanyl may be used as a first line intravenous analgesic agent, either alone or in combination with sedative agents, in post-transplant children in the intensive care unit. (Level 3, Weak)

8. Acetaminophen may be used at standard dosing to improve early postoperative analgesia and decrease opioid requirements in children after LT. (Level 3, Weak)

9. Dexmedetomidine may be considered as a primary agent for sedation or as an adjunct to opioid agents in the immediate post-transplant period. (Level 3, Weak)

10. Ketamine may be added in children who are not adequately sedated with alpha-2-agonists, opioids and benzodiazepines (Level 3, Weak)

11. Institutional best practice scoring systems should be implemented to avoid over or under use of sedatives and analgesics. (Level 3, Strong)

Nutrition
12. Enteral nutrition should be initiated as soon as possible in the early post-transplant period (Level 3, Strong).

13. A standardized feeding protocol should be implemented to support early introduction of enteral feeds after liver transplant. (Level 3, Strong)

14. If enteral feeding is not possible within 5-7 days after transplant, or if there is inability to advance enteral nutrition, total parenteral nutrition may be initiated. (Level 3, Weak).

Renal support
15. Pediatric liver transplant recipients should be monitored closely for acute kidney injury immediately post-transplant, with initiation of fluid and electrolyte management strategies as needed. (Level 3, Strong)

Question 2: What intra- and post- operative management strategies reduce the risk of surgical complications after pediatric LT?

Vascular complications: Strategies for prevention
16. Planning to optimize arterial and portal inflow should begin pre-operatively, with evaluation of clinical risk factors and of portal vein and hepatic artery size and blood flow using ultrasound and/or cross-sectional imaging (Level 3, Strong)

17. Portal vein reconstruction with vein conduits should be utilized to replace atretic native portal veins that are not amenable to simple excision. (Level 3, Strong)

18. Fresh allogeneic or autogeneic vein grafts should be considered the best conduit option, over cold-stored autografts or synthetic material. (Level 4, Strong)

19. Ligation or embolization of portosystemic shunts to modulate portal flow should be utilized for known large shunts with demonstrated low portal pressure or flow intraoperatively, and for those contributing to portal vein thrombosis or stenosis postoperatively. (Level 4, Strong)

20. An expanding "growth factor" stitch is recommended for all running portal sutures to allow for anastomotic growth and avoid portal vein stenoses. (Level 4, Strong)

21. Interrupted sutures and microsurgical techniques may be helpful for hepatic artery reconstruction to prevent hepatic artery stenosis or thrombosis. (Level 4, Weak)

22. Vascular outflow for the liver graft may be established with caval replacement or “piggyback” reconstruction. (Level 4, Weak)

Anti-coagulation after pediatric liver transplant
23. Low-dose aspirin to prevent hepatic artery thrombosis is recommended for all pediatric liver transplant recipients, for up to 12 months after transplant. (Level 4, Strong)

24. Systemic anticoagulation may be used to reduce the risk of hepatic artery or portal vein thrombosis in higher-risk children (<2 years of age, intra-operative thrombosis, segmental grafts, vascular conduits), but bleeding risk increases with more aggressive anti-coagulation. (Level 4, Weak)

Diagnosis of vascular complications
25. Routine doppler ultrasound evaluation of the graft should be utilized post-operatively to evaluate for early vascular complications, including insufficient inflow and outflow. (Level 2, Strong)

26. Doppler ultrasound should be used as the primary diagnostic method for hepatic artery thrombosis. (Level 3, Strong)

27. Additional imaging to confirm hepatic artery thrombosis should not delay intervention, although it may increase sensitivity for diagnosis if achievable within time constraints for optimal intervention. (Level 3, Strong)

28. Any biliary leak or stricture, regardless of timing, should prompt evaluation of hepatic artery patency. (Level 2, Strong)

Treatment of portal vein thrombosis and stenosis: indications and strategies
29. Operative intervention with revision and thrombectomy is favored over percutaneous options for portal vein thrombosis or stenosis in the early post-operative period. (Level 5, Strong)

30. For clinically significant portal vein stenosis, initial treatment should be with balloon venoplasty, with stenting or surgical revision reserved for refractory stenoses. (Level 4, Strong)

31. If late portal vein thrombosis is causing portal hypertension or graft dysfunction, percutaneous interventional radiology approaches with portal vein recanalization and stenting should be considered. (Level 3, Strong)

32. For symptomatic late portal vein thrombosis or stenosis not amenable to endovascular therapy, Meso-Rex shunts should be considered by surgeons with experience. (Level 3, Strong)

Treatment of hepatic artery thrombosis and stenosis: indications and strategies
33. Urgent re-transplantation is recommended for acute graft failure due to early hepatic artery thrombosis. (Level 4, Strong)

34. For hepatic artery stenosis or thrombosis less than 2 weeks after transplant without significant graft dysfunction or biliary necrosis, operative intervention and arterial revision is recommended over endovascular intervention. (Level 3, Strong)

35. For intra-operative hepatic artery thrombosis , intra-arterial lytic therapy should be considered intra-operatively. (Level 3, Strong)

36. Late hepatic artery stenosis may be treated with percutaneous angioplasty, with or without stenting, or surgical revision, depending on available surgical and interventional radiology experience. (Level 3, Weak)

37. In pediatric liver transplant recipients with hepatic artery thrombosis and diffuse biliary strictures, recurrent cholangitis or hepatic abscess, re-transplantation is recommended. (Level 4, Strong)

38. Late hepatic artery thrombosis does not require re-transplantation if it remains clinically silent, with no evidence of progressive biliary or other graft dysfunction. (Level 5, Strong)

Treatment of hepatic vein thrombosis or stenosis: indications and strategies
39. Early hepatic vein obstruction warrants surgical exploration to confirm obstruction is not caused by graft compression or twisting of the hepatic outflow, and to allow for HV anastomotic revision if needed. (Level 5, Strong)

40. Percutaneous venoplasty should be considered for hepatic obstruction outside the immediate post-operative period, although repeated endovascular interventions for re-stenosis may be required. (Level 3, Strong)

41. The use of hepatic vein or caval stents should be done selectively and with caution, particularly in smaller children. (Level 4, Strong)

42. Recurrent hepatic vein obstruction despite endovascular interventions may be treated with surgical revision or, in the case of advanced graft fibrosis, retransplant. (Level 5, Weak)

Biliary complications: Strategies for prevention
43. Duct-to-duct biliary anastomosis can be considered in pediatric liver transplant, but its use remains limited by size and length of recipient and donor bile ducts. (Level 4, Weak)

44. Routine stenting of the biliary anastomosis is not necessary in pediatric liver transplant. (Level 3, Strong)

Treatment of biliary complications: Bile leaks
45. Biliary leaks in the early peri-operative period that present with sepsis or biliary peritonitis, or obvious bile in the drain, should warrant consideration of operative exploration and revision. (Level 4, Strong)

46. In the absence of systemic symptoms, suspected low volume bile leaks can be managed expectantly with close observation. (Level 4, Weak)

Diagnosis of biliary strictures
47. If clinical suspicion for biliary stricture is high, based on liver biopsy, cholestatic labs, or magnetic resonance imaging, interventional radiology cholangiography or endoscopic retrograde cholangiography (ERCP) should be utilized for definitive diagnosis and treatment. (Level 4, Strong)

Treatment of biliary strictures
48. Anastomotic strictures or other focal extrahepatic strictures should be initially treated with sequential cholangioplasty and stenting. (Level 3, Strong)

49. Treatment of strictures with endoscopic versus percutaneous transhepatic cholangioplasty and stenting should be guided by center expertise and experience. For duct-to-duct anastomoses, endoscopic intervention is favored whenever feasible. (Level 4, Strong)

50. In children with chronic extrahepatic strictures refractory to endoscopic or percutaneous interventions who do not yet have advanced fibrosis or cirrhosis, operative biliary revision should be performed. (Level 4, Strong)

Question 3: How can immunosuppression after liver transplant be managed to improve liver function and survival while minimizing adverse effects for the child’s overall health?

Induction Immunosuppression
51. Antibody induction with corticosteroid minimization and delayed calcineurin-inhibitor initiation can be considered in children with renal dysfunction or other specific toxicity related to steroids and calcineurin-inhibitors. (Level 3, Weak)

Maintenance Immunosuppression
52. Tacrolimus is recommended as the primary maintenance immunosuppressant after pediatric liver transplant. (Level 5, Strong)

53. Corticosteroids should be withdrawn within the first 3-6 months post-transplant in most children to promote growth and minimize long-term adverse effects. (Level 2, Strong)

54. Most children should transition to tacrolimus monotherapy within 6-24 months after transplant. (Level 5, Strong)

55. Adjunctive immunosuppression with mycophenolic acid or mTOR inhibitors may be considered to limit adverse effects associated with calcineurin inhibitors. (Level 3, Weak)

Immunosuppression Withdrawal/Minimization

Surveillance Biopsy
56. Surveillance liver biopsy may be used in stable children with normal liver indices to guide individualized immunosuppression adjustment. (Level 3, Weak)

Immunosuppression Minimization
57. Minimization of immunosuppression to once-daily tacrolimus monotherapy (non-extended release formulation) may be considered in pediatric recipients ≥4 years post-transplant with persistently normal liver tests and surveillance liver biopsy without significant inflammation or fibrosis. (Level 3, Weak)

58. Graft health must be closely monitored during immunosuppression minimization, and routine surveillance for rejection must continue afterwards. (Level 5, Strong)

Immunosuppression Withdrawal
59. Elective withdrawal of immunosuppression may be considered in pediatric recipients at least 4-5 years post-transplant with persistently normal liver tests and surveillance liver biopsy without significant graft injury, as defined in criteria from previous trials. (Level 2, Weak)

60. Pediatric liver transplant recipients must be closely monitored during and after immunosuppression withdrawal, with prompt diagnostic workup and potential re-initiation of immunosuppression if graft inflammation or injury is suspected. (Level 2, Strong)

61. A surveillance biopsy should be performed 3-5 years after immunosuppression minimization or withdrawal to assess for subclinical liver injury. (Level 5, Strong)

Question 4: What is the preferred approach to the diagnosis and treatment of allograft rejection in pediatric liver transplant?

Diagnosis
62. Serial measurements of ALT, AST, GGT, bilirubin should be used as the primary non-invasive method for detecting graft dysfunction, caused by rejection or other complications, during routine monitoring. (Level 5, Strong)

63. Liver biopsy should be used for definitive diagnosis and classification of rejection. Liver histopathology should be utilized to guide major escalation of immunosuppression or addition of new medications. (Level 5, Strong)

64. Non-invasive biomarkers should not be utilized for diagnosing rejection in pediatric liver transplant recipients. (Level 3, Strong)

T-cell mediated rejection (TCMR)
65. Initial treatment for mild or clinically suspected T-cell mediated rejection should include optimizing current immunosuppression levels. (Level 4, Strong)

66. Additional treatment for mild T-cell mediated rejection, if not responsive to optimizing current immunosuppression, should include initiation of corticosteroids. (Level 5, Strong)

67. Initial treatment for moderate to severe T-cell mediated rejection should include corticosteroids, in addition to optimizing current immunosuppression. (Level 5, Strong)

68. For children on tacrolimus monotherapy, addition of a second agent like mycophenolate may be helpful in controlling rejection but is not always necessary. (Level 5, Weak)

69. Lymphocyte-depleting antibody treatment should be used as second-line treatment for T-cell mediated rejection that is not responsive to corticosteroids. (Level 4, Strong)

Plasma-cell rich rejection (PCR)
70. Plasma-cell rich rejection should be considered in children with graft dysfunction and characteristic serologic or histologic features. (Level 3, Strong)

71. Plasma-cell rich rejection may be treated with corticosteroids and addition of azathioprine or mycophenolic acid to maintenance calcineurin-inhibitors. (Level 4, Weak)

Chronic rejection
72. Diagnosis of chronic rejection in children should be made based on laboratory evidence of graft dysfunction plus characteristics findings of ductopenia and obliterative arteriopathy on liver biopsy. (Level 5, Strong)

73. Children diagnosed with chronic rejection should be evaluated for an antibody-mediated component, using donor-specific antibody testing and liver histopathology. (Level 4, Strong)

74. If graft dysfunction from chronic rejection persists despite adequate calcineurin-inhibitor therapy, an mTOR inhibitor or mycophenolate may be added. (Level 4, Weak)

Antibody-mediated rejection (AMR)
75. After ABO-incompatible liver transplantation, elevated isoagglutinin titers should be treated with antibody-depleting therapy to prevent acute antibody-mediated rejection. (Level 3, Strong)

76. Measurement of donor-specific antibody titers should be the initial evaluation for suspected antibody-mediated rejection in a child with graft dysfunction. (Level 3, Strong)

77. Liver biopsy, and evaluation for other causes of graft dysfunction, should be performed prior to initiating treatment for antibody-mediated rejection. C4d staining should be performed in these biopsies, but may not be conclusive. (Level 4, Strong)

78. Increase in current immunosuppression, and/or corticosteroids, can be used as initial treatment for suspected or mild antibody-mediated rejection. (Level 4, Weak)

79. Antibody-mediated rejection that is moderate, severe, or refractory to corticosteroids can be treated with antibody-depleting therapy and/or biologic therapy. (Level 4, Weak)

80. Donor-specific antibody monitoring is not recommended as routine surveillance in children with normal graft function and no previous AMR (Level 3, Strong)

Question 5: How should children be monitored for renal and metabolic adverse effects of immunosuppression?

Chronic kidney disease and hypertension
81. Transplant teams should evaluate a pediatric liver transplant recipient’s renal function at every clinic visit, annually at minimum, ideally using CKiD U25 eGFR. (Level 3, Strong)

82. Minimization of nephrotoxic medications should be considered at all phases after liver transplant. (Level 4, Strong)

83. Refer to nephrology with an eGFR <90 mL/minute/1.73 m2, CKD Stage II or greater (Level 5, Strong).

84. Surveillance for hypertension with manual blood pressure measurements and comparison to age-based BP percentiles should occur at every transplant clinic visit, annually at minimum. Level 3, Strong)

85. Consider 24-hour ambulatory blood pressure monitoring in older children and adolescents every 2 years, and consider referral to nephrology if blood pressure abnormalities are detected. (Level 3, Weak).

86. For persistent hypertension, initiate treatment with calcium channel blockers and consider referral to nephrology. (Level 3, Strong)

Post-transplant diabetes mellitus
87. Pediatric liver transplant recipients should be routinely monitored for hyperglycemia via blood glucose and for symptoms of diabetes at every clinic visit or hospitalization. (Level 3, Strong)

88. At a minimum, pediatric liver transplant recipients should be screened annually with fasting glucose and hemoglobin A1c for pre-diabetes and diabetes. (Level 3, Strong)

89. Fasting blood glucose ≥ 100 mg/dL or random blood glucose ≥ 200 mg/dL should prompt additional laboratory testing and clinical screening for diabetes mellitus. (Level 3, Strong)

90. Children with hyperglycemia or elevated HbA1c on routine laboratory testing should undergo oral glucose tolerance testing, or referral to pediatric endocrinology for additional testing. (Level 4, Strong)

Question 6: What are the recommended strategies for prevention and/or treatment of infections and their complications in children after liver transplant?

Strategies for infection prevention
91. Hepatologists and primary care physicians should follow recommendations specifically for vaccinating immunocompromised children that are approved by immunization advisory committees formed of content experts such as the American Academy of Pediatrics and/or the Infectious Disease Society of America. (Level 5, Strong)

92. Pediatric liver transplant recipients should consult with a travel medicine or infectious disease specialist before traveling to regions of the world with higher rates of infection, to be advised on vaccine-preventable illnesses and antimicrobial prophylaxis, based on destination. (Level 5, Strong)

Human Papillomavirus (HPV)
93. Transplant recipients who are 9 years of age and older should receive the recommended series of human papillomavirus vaccines. (Level 2, Strong)

Respiratory Syncytial Virus (RSV)
94. All transplant recipients younger than 8 months of age, born shortly before or during RSV season, should receive one dose of the RSV monoclonal antibody, nirsevimab, if their mother did not receive RSV vaccine during pregnancy, the mother’s RSV vaccination status is unknown, or the infant was born less than 14 days following maternal RSV vaccination. (Level 1, Strong)

95. Transplant recipients aged 8 through 19 months who are severely immunocompromised and are entering their second RSV season should receive a dose of nirsevimab. (Level 1, Strong)

96. Routine precautions with thorough handwashing should be utilized while changing diapers of infants for at least 2 weeks after rotavirus vaccine due to risk for viral shedding. (Level 3, Strong)

Measles, Mumps, Rubella (MMR) and Varicella Zoster Virus (VZV)
97. Household contacts of liver transplant recipients should avoid vaccinia/smallpox vaccination but should receive routine live attenuated vaccines (Varivax, MMR, Rotavirus). (Level 3, Strong)

98. Live vaccines (against measles, mumps, rubella and varicella zoster virus) should be considered for pediatric LT recipients with stable graft function and on low/medium immunosuppression (no more than two immunosuppressive agents, tacrolimus or sirolimus trough <8ng/mL, and steroids <0.5 mg/kg/day). (Level 3, Strong)

Influenza and Coronavirus disease 2019 (COVID-19)
99. All transplant recipients should receive yearly influenza and COVID-19 vaccinations following recommendations for immunocompromised children that are approved by immunization advisory committees formed of content experts such as the American Academy of Pediatrics and/or the Infectious Disease Society of America. (Level 3, Strong)

Pneumocystis jiroveci pneumonia
100. In pediatric LT recipients, prophylaxis against pneumocystis jiroveci pneumonia should be continued for at least 3 months post-transplant. (Level 5, Strong)

Epstein-Barr Virus (EBV)
101. EBV serostatus should be determined for donors and recipients prior to liver transplant. (Level 3, Strong)

102. EBV viral loads should be monitored post-transplant using a quantitative nucleic acid–based viral load assay. (Level 3, Strong)

103. When there are clinical features suggestive of PTLD, management should include reduced immunosuppression with/without additional specific therapy based on staging and severity. (Level 4, Strong)

Cytomegalovirus (CMV)
104. Monitoring for CMV infection or disease should be performed with a quantitative nucleic acid–based viral load assay. (Level 3, Strong)

105. For CMV donor or recipient seropositive children (D+ or R+), a CMV prevention strategy immediately after transplant with oral valganciclovir is recommended, which can consist of prophylaxis, pre-emptive therapy or sequential therapy. (Level 3, Strong)

106. No specific prophylactic strategy is routinely indicated for CMV donor-negative/recipient-negative (D-/R-) children. (Level 4, Strong)

107. CMV D+ or R+ pediatric LT recipients may continue to have monitoring for CMV viremia while on prophylaxis, due to the risk for breakthrough infection. (Level 4, Weak)

108. Valganciclovir is the recommended initial antiviral therapy for mild to moderate CMV disease. (Level 4, Strong)

109. Intravenous ganciclovir is recommended for severe or life-threatening CMV disease. (Level 4, Strong)

110. If a child has CMV infection with evidence of viral resistance, perform genotypic testing for resistance mutations and treating with second-line therapies (maribavir/foscarnet/cidofovir). (Level 4, Strong)

Question 7: What interventions are recommended to optimize a child’s growth and weight status in pediatric LT recipients?

111. After liver transplant, growth should be tracked using age and sex appropriate height weight, and weight-for-length or BMI percentiles at every liver transplant and primary care appointment. (Level 3, Strong)

112. Children with weight-for-length or BMI percentile approaching or exceeding the 85th percentile for sex and age should receive targeted counselling about and treatment for overweight/obesity and its complications. (Level 5, Strong)

113. Long-term corticosteroid use, beyond the initial post-transplant period should be avoided due to the detrimental effects on linear growth and bone health. (Level 4, Strong)

Question 8: What other preventive care is needed to support children’s health after liver transplant?

Dental Caries
114. Pediatric liver transplant recipients should be counselled annually on oral hygiene and have bi-annual dental exams (Level 3, Strong).

Malignancy
115. Pediatric liver transplant recipients should be counselled annually on limiting sun exposure and using sunscreen as measures to lower long-term risk of skin cancer. (Level 5, Strong)

116. Liver transplant recipients with primary sclerosing cholangitis and inflammatory bowel disease should undergo surveillance colonoscopy for colorectal cancer every 1-2 years, starting at 15 years of age. (Level 2, Strong)

117. Recipients transplanted for primary sclerosing cholangitis without known inflammatory bowel disease should consider surveillance colonoscopy every 5 years. (Level 5, Weak)

Substance use and sexually transmitted infections
118. Avoidance of higher risk behaviors (such as alcohol, tobacco and recreational drug use) and strategies for sexually transmitted infection prevention (including vaccination, barrier methods, and sexual abstinence) should be discussed at least annually with adolescent and young adult transplant recipients, either by the transplant team or other specialists such as adolescent medicine or gynecology. (Level 5, Strong)

119. Screening and treatment for sexually transmitted infections in pediatric liver transplant recipients should follow guidance for immunocompromised adolescents or young adults. (Level 5, Strong).

Reproductive Health
120. Fertility, contraception, and family planning should be discussed annually with adolescent and young adult liver transplant recipients. (Level 4, Strong)

121. Long-acting reversible contraceptives, such as hormonal intrauterine devices or implants, should be considered. (Level 4, Strong)

Allergies
122. Consider evaluation for food allergies in children after liver transplant with symptoms suggestive of allergic disease, including asthma, dysphagia, recurrent rash, and others. (Level 4, Weak)

Question 9: What strategies can the transplant team use to recognize and address developmental and mental health challenges that children face after liver transplant?

Neurodevelopmental
123. Clinicians should offer an appropriate referral to developmental or other accessible specialists for diagnosis and care at the earliest apparent signs of a neurodevelopmental deficit or delay. (Level 5, Strong).

Mental health
124. Pediatric liver transplant recipients should be screened at least annually for a history of traumatic exposure. (Level 4, Strong)

125. When post-traumatic stress disorder is suspected, referral for further consultation and treatment with a mental health professional should be made. (Level 4, Strong)

Intellectual/academic functioning
126. Transplant teams should strongly consider referral for formal intellectual/executive function assessment and special education supports if there is known or suspected decrease in academic or intellectual performance, evidenced by parental concerns, school referrals, or clinical impression. (Level 3, Strong).

Physical functioning and motor development
127. Transplant teams should be aware of physical functioning in children who are post-transplant. Consider quantitative and qualitative assessment of pediatric liver transplant recipients’ physical activity and potential barriers to physical activity with referral for physical therapy or other exercise programs when limitations are recognized. (Level 4, Weak)

128. Transplant teams should encourage and facilitate return to school and other age/developmentally appropriate activities and functioning in all children after liver transplant, as soon as medically appropriate. (Level 5, Weak).

Quality of life
129. The transplant team should consider routinely assessing each child’s post-transplant quality of life via targeted questions to the patient and parent, or by using a validated questionnaire. (Level 5, Weak).

130. When using quality of life assessment tools, clinicians may evaluate each domain to identify specific areas of concern, and they should try to address identified concerns. (Level 5, Weak).

Adherence to immunosuppressant medications
131. The transplant team should routinely assess adherence to immunosuppressant medications using an objective method that does not increase patient burden (for example, medication level variability index). (Level 2, Strong).

132. Electronic adherence monitors can be considered for enhanced monitoring in recipients known to be non-adherent but cannot be recommended for adherence screening. (Level 2, Weak)

133. The transplant team should address non-adherence by evaluating risk factors and causes and offering strategies to address non-adherence. (Level 5, Strong).

Question 10: How can the transplant team best support an adolescent or young adult’s transition from pediatric to adult care?

Six Core Elements of Health Care Transition
134. A multidisciplinary, standardized approach to transition planning which emphasizes partnership and collaboration between pediatric and adult providers, such as the Six Core Elements of Health Care TransitionTM, should be utilized to establish an effective healthcare transition program. (Level 5, Strong).

Transition Readiness Assessment
135. Transition planning should be initiated by the pediatric team in early adolescence, around 10-12 years of age. (Level 5, Strong).

136. Annual assessment of transition readiness using standardized assessment tools should be used in transition planning. (Level 5, Strong).

Transfer of Care
137. The initial transfer of care appointment to the adult transplant team, and labs, should be scheduled within a suitable time frame, ideally within 3 months of the last pediatric appointment. (Level 5, Strong)

Role of the Adult Health Care Provider
138. The transition process should not conclude at the time of transfer. The adult team should continue to support the transition process after the transfer of care and through early adulthood. (Level 5, Strong).

Question 11: How should transplant teams detect and address social determinants of health that impact children’s long-term health after liver transplant?

139. Transplant teams should continually reassess the multifaceted social determinants of health faced by pediatric transplant recipients and their caregivers. (Level 3, Strong)

140. Transplant teams should discuss and help provide resources to ensure access to medications, health care and surveillance for all pediatric liver transplant recipients. (Level 3, Strong)