Monitoring Practices After Pediatric Liver Transplantation

Abstract

Objectives: This study sought to understand the current monitoring practices after pediatric liver transplantation, 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 liver transplant 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 liver transplants 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 liver transplants after the first year post-transplant. While common themes emerge, future studies will be needed to connect protocols to outcomes to determine best practice.