Evaluation of the Pediatric Patient for Liver Transplantation: 2014 Practice Guideline by the American Association for the Study of Liver Diseases, American Society of Transplantation and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Abstract

PreambleCurrent American Association for the Study of Liver Diseases (AASLD) liver transplant evaluation guidelines include both adult and pediatric patients.1 While pediatric liver transplants account for 7.8% of all liver transplants in the United States, sufficient differences between pediatric and adult patients seeking liver transplantation (LT) now require independent, yet complementary documents.This document will focus on pediatric issues at each level of the evaluation process.Disease categories suitable for referral to a pediatric LT program are similar to adults: acute liver failure, autoimmune, cholestasis, metabolic or genetic, oncologic, vascular, and infectious.However, specific etiologies and outcomes differ widely from adult patients, justifying independent pediatric guidelines.Data supporting our recommendations are based on a Medline search of the English language literature from 1997 to the present.Intended for use by physicians, these recommendations suggest preferred approaches to the diagnostic, therapeutic, and preventive aspects of care.They are intended to be flexible, in contrast to standards of care, which are inflexible policies to be followed in every case.Specific recommendations are based on relevant published information.To more fully characterize the available evidence supporting the recommendations, the AASLD Practice Guidelines Committee has adopted the classification used by the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) workgroup with minor modifications (Table 1).The classifications and recommendations are based on three categories: the source of evidence in levels I through III; the