AASLD AST practice guidelines: Non-graft-related complications after liver transplantation

Guidelines from the American Association for the Study of Liver Diseases (AASLD) and American Society of Transplantation (AST) on the prevention, diagnosis, and post-transplant management of non-graft-related complications beyond the first 90 days after liver transplantation in adults were published in Liver Transplantation by Sharma et al. The guidelines were developed by a multidisciplinary writing group and included 87 evidence-based recommendations.  

Key data: Pharmacologic therapy is recommended for recipients with osteopenia plus a hip or spine fragility fracture, T-score ≤−2.5, or a 10-year fracture risk assessment tool (FRAX) risk ≥20% for major osteoporotic fracture or ≥3% for hip fracture. Recipients should not receive live virus vaccines and should discuss vaccinations with their health providers. When either the donor or recipient is cytomegalovirus (CMV) seropositive, weekly CMV polymerase chain reaction (PCR) testing for 100 days should be used for CMV prevention. Tobacco users should receive smoking cessation education. In recipients with diabetes mellitus or hypertension, early corticosteroid withdrawal is recommended while balancing rejection risk. In patients with chronic kidney disease, calcineurin inhibitors should be minimized but not eliminated during the first year after transplant.   

Key learning: Multidisciplinary care and partnership between primary care physicians and transplant centers are essential for the long-term care of adult liver transplant recipients.