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Monitoring Practices After Pediatric Liver Transplantation
Voytek Slowik1, Jamie L Ryan1, Amit A Shah2
1From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO.
Insights
Pediatric liver transplant (LT) monitoring varies widely, with most centers reducing follow-up after the first year. Surveillance biopsies and routine imaging are uncommon, highlighting the need for outcome-based best practice guidelines.
Area of Science:
- Pediatric Gastroenterology
- Transplant Hepatology
- Clinical Practice Guidelines
Background:
- Post-pediatric liver transplantation (LT) care requires standardized monitoring protocols.
- Current practices for follow-up clinic visits, laboratory testing, biopsies, and imaging after LT are not well-defined.
- Understanding variations in LT management is crucial for improving patient outcomes.
Purpose of the Study:
- To assess current monitoring practices in pediatric liver transplantation.
- To identify center and provider characteristics influencing post-LT management.
- To establish a baseline for developing evidence-based pediatric LT care guidelines.
Main Methods:
- Cross-sectional survey distributed to pediatric LT providers.
- Data collected from centers participating in the Society of Pediatric Liver Transplantation (SPLIT) registry.
- Survey conducted between February 2020 and April 2021, achieving a 79% response rate.
Main Results:
- Significant variation exists in clinic visit and laboratory monitoring frequency post-LT.
- Annual clinic visits and quarterly lab tests are common after the first year.
- Surveillance liver biopsies are infrequently performed within the first year but common thereafter; imaging is typically on-demand.
Conclusions:
- Pediatric liver transplant centers exhibit considerable diversity in post-transplant management strategies.
- While some common practices exist, significant variability remains, particularly after the initial year.
- Further research is necessary to link specific monitoring protocols to patient outcomes and define optimal care pathways.
Objectives:
This study sought to understand the current monitoring practices after pediatric liver transplantation (LT), specifically regarding follow-up clinic visits, outpatient laboratory testing, protocol biopsies, and diagnostic imaging, and to identify potential center and provider characteristics associated with such practices.
Methods:
A cross-sectional survey of pediatric LT providers at centers participating in the Society of Pediatric Liver Transplantation (SPLIT) registry was conducted from February 2020 to April 2021.
Results:
The overall response rate was 79% (38/48 SPLIT centers), with the majority representing large volume centers (>10 LTs per year). Frequency of clinic visits and laboratory monitoring varied by center, but all centers decreased frequency after the first post-transplant year. The most common practice included an annual clinic visit and laboratory sampling every 2-3 months. Surveillance liver biopsy is seldom done during the first post-transplant year, while being routinely performed by 50% of centers after this time period. Centers forgoing surveillance biopsies assert that the results would likely not change management. Only 39% of centers have a hepatologist perform the liver biopsy while the remaining centers consult interventional radiology. Most diagnostic imaging is obtained only as needed. Routine abdominal ultrasounds were obtained by only 50% of responding centers after the first year post-transplant.
Conclusions:
SPLIT centers vary widely in the routine management of LTs after the first year post-transplant. While common themes emerge, future studies will be needed to connect protocols to outcomes to determine best practice.
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