AASLD AST Practice Guideline on adult liver transplantation: Diagnosis and post-transplant management of non-graft–related complications

Long-term mortality after liver transplantation (LT) largely reflects complications of immunosuppression, recurrent disease, and medical and surgical comorbidities, including metabolic syndrome, chronic kidney disease, cardiovascular disease, malignancies, and hernias. This document aims to provide best practice guidelines for the preventative and disease-specific management of non-graft-related complications in adult recipients beyond the first 90 days after liver transplant. A multidisciplinary writing group of transplant experts was tasked to formulate clinical questions (in PICO format) that arise during routine management of adult LT recipients. A systematic literature search was performed by a medical librarian. The expert panel reviewed the literature, generated guideline recommendations, and rated the level of evidence for each recommendation based on the Oxford Center for Evidence-Based Medicine. The panel categorized the strength of recommendations based on the level of evidence, risk-benefit ratio, and patient preferences. Multidisciplinary care and partnership between the transplant center and the primary care physician are essential for long-term care of the transplant recipient. Significant components of non-graft management guidelines are derived from retrospective cohort studies, systematic reviews, and extrapolation of data from the general population. This gap highlights the unmet need for robust prospective studies addressing the long-term care of liver transplant recipients.