Guidelines for the long-term care of pediatric liver transplantation have been published (Liver Transplantation 2013; 19: 798-625). At the time of this writing, it has not been uploaded to the AASLD website which archives a large number of guidelines related to liver disorders (AASLD: Practice Guidelines).

Due to the extensive nature of the guidelines, I will not try to summarize them, though I think having this reference is useful.  To see how familiar you are with current recommendations, you may want to take the following quiz:

1. Which of the following are not part of routine liver transplantation care, according to the authors?

• a. Assessment of school functioning
• b. Assessment for hearing loss
• c. Protocol liver biopsy at 1 year
• d. Resumption of full physical activity by 12 weeks after LT

2. Which of these vaccines should be given (if age appropriate) before LT but not afterwards?

• a. Measles, Mumps, Rubella
• b. Varicella
• c. Rotavirus
• d. Human papillomavirus

3. True/False: Tattoos and piercings are acceptable if the child has received the hepatitis B vaccine.

4. Options for treating chronic rejection, which is a major cause of late graft loss, include all of the following except:

• a. Give rituximab
• b. Switch to mycophenolate
• c. Switch to rapamycin
• d. Higher doses of tacrolimus

5. Target level for tacrolimus trough for patients more than 1 year after transplantation?

• a. 10-12 ng/mL
• b. <10 ng/mL
• c. 8-10 ng/mL
• d. <8 ng/mL
• e. <6 ng/mL

6. True statements regarding cytomegalovirus infection include all of the following except

• a. Prophylactic intravenous ganciclovir is indicated for CMV donor-positive/recipient negative but not for CMV donor-negative/recipient-negative
• b. Second-line treatments include foscarnet, acyclovir, and cidofovir
• c. Genotypic testing for mutations can be done to determine if CMV is resistant to ganciclovir
• d. Ganciclovir resistance should be considered in patients with rising CMV loads despite at least 14 days of therapy

7. Minimal recommended time for Pneumocystis jirovecii prophylaxis, according to the authors:

• a. 0 months
• b. 3 months
• c. 6 months
• d. 12 months
• e. 3 years

Answers:

1. C, 2. D, 3. True, 4. A, 5. E, 6. B, 7. C

Related blog posts:

• Once Daily Tacrolimus for Liver Transplant Recipients | gutsandgrowth
• Liver transplant outcomes in the boonies | gutsandgrowth