Monitoring

  • A clinical review and standard serum liver tests are recommended every 6-12 months, depending on risk stratification. The tests include bilirubin, albumin, alkaline phosphatase, aspartate aminotransferase, platelet count, and prothrombin time. Every 2-3 years, liver elastography and/or serum fibrosis tests are recommended. Every year, liver ultrasound and/or abdominal magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) are suggested.[2]

  • Bone mineral density scanning using dual energy x-ray absorptiometry is suggested in all patients at diagnosis and at 2- to 3- or 4-year intervals (based on risk factors) to exclude osteoporosis.[2][3][29][30][37][38]

  • Periodic laboratory testing to evaluate for fat-soluble vitamin deficiencies is recommended.[29]

  • Screening for hepatocellular carcinoma in patients with cirrhosis typically includes liver ultrasound and serum alpha-fetoprotein measurement every 6 months.[104][105]​​

  • Screen for serum antibodies to hepatitis A and hepatitis B virus so that immunisation can be offered if there is no evidence of previous infection or immunisation.

  • In patients with primary sclerosing cholangitis who do not have, or are not diagnosed with, inflammatory bowel disease (IBD), ileocolonoscopy should be repeated (US guidance) or considered (European guidelines) every 5 years, or whenever they have symptoms suggestive of IBD.[2][3]

  • From the age of 15 years, all patients with co-existing IBD should undergo high-definition surveillance colonoscopy regularly due to a high risk of colorectal cancer. US guidance suggests 1- to 2-year surveillance intervals, whereas European guidelines recommend surveillance annually, with 1- to 2-year intervals if there is no inflammatory activity.[2][3][29][30][39] Surveillance endoscopy after liver transplantation can continue as per the pre-transplant recommendations.[2][3]

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