(1-B) The child’s diagnostic evaluation as it relates Pirfenidone in vitro to their primary disease, associated comorbidities, subspecialty consultations, and management strategies should be documented and provided by the primary pediatric specialist responsible for management of the child’s liver disease. These documents should include clinical assessments, results of laboratory and diagnostic studies, medical and nutritional management,

surgical procedures, pathology reports and slides, as well as radiographic reports and copies of the radiographs. Personal communication between a member of the LT evaluation team and the child’s physician will identify clinical, social, and psychological factors that may not be apparent in the medical record. New or worsening comorbidities may be identified during the LT evaluation.[9] 6. A review of the local records by the LT team prior to the LT evaluation will inform the evaluation schedule and enable affirmation

of the primary diagnosis, Palbociclib assessment of comorbidities, and identify technical challenges related to LT. (2-B) 7. In collaboration with the local primary pediatric specialist, management of the primary disease and comorbidities should be reviewed and optimized. (2-B) Complications associated with endstage liver disease include ascites, pruritus,

portal hypertension, malnutrition, vitamin deficiencies, and delayed growth and development.[10] In cirrhosis patients, accumulation of ascites is a result of portal hypertension, vasodilatation, and hyperaldosteronism.[11] Hypoalbuminemia is an additional risk factor for ascites. Ultrasonography is sensitive enough to detect as little as an ounce of intra-abdominal fluid, while significantly more is required for MCE it to be detected on physical examination. Decisions to initiate diuretic therapy to manage ascites are ill-defined. Abdominal distension alone does not reliably predict ascites, as organomegaly and vascular congestion of the bowel may also contribute to distension. Fluid that is easily palpated between the abdominal wall and the surface of the liver (“ballotable fluid”) would suggest sufficient ascites to warrant therapy; its presence can be used to judge response to therapy. Initial treatment includes spironolactone and a “no-added” salt diet. Loop-diuretics should be used with caution as overaggressive diuresis can precipitate hepatorenal syndrome. For hospitalized patients with significant ascites, intravenous albumin, with or without an accompanying diuretic, can improve diuresis and response to diuretics.