AASLD/AST practice guidelines: Diagnosis and management of 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 graft-related complications after adult liver transplantation were published in Liver Transplantation by Te et al. The evidence-based recommendations address rejection, graft complications, immunosuppression, and recurrent disease after adult liver transplantation.

Key data: Living-donor liver transplantation should be considered for appropriate candidates, with close monitoring for biliary and vascular complications. Donation after circulatory death (DCD) grafts achieve comparable 1‑year outcomes to donation after brain death (DBD) grafts and should be considered in experienced liver transplant programs, with machine perfusion or normothermic regional perfusion recommended to reduce early allograft dysfunction and ischemic biliary complications. Dynamic scoring systems (Liver Graft Assessment Following Transplantation [L-GrAFT], Early Allograft Failure Simplified Estimation [EASE]) are recommended to improve prediction of early graft failure. Vascular and biliary complications require prompt diagnosis and intervention. Pharmacologic prophylaxis for early allograft dysfunction is not routinely recommended.

Key learning: The AASLD/AST guidelines provide practical, evidence-based strategies to improve graft survival through early complication recognition and management after liver transplantation.