Immunosuppression in pediatric liver transplant recipients: Unique aspects

Tamir Miloh, Andrea Barton, Justin Wheeler, Yen Pham, Winston Hewitt, Tara Keegan, Christine Sanchez, Pinar Bulut, John Goss

Research output: Contribution to journalReview articlepeer-review

29 Scopus citations

Abstract

Pediatric liver transplantation has experienced improved outcomes over the last 50 years. This can be attributed in part to establishing optimal use of immunosuppressive agents to achieve a balance between minimizing the risks of allograft rejection and infection. The management of immunosuppression in children is generally more complex and can be challenging when compared with the use of these agents in adult liver transplant patients. Physiologic differences in children alter the pharmacokinetics of immunosuppressive agents, which affects absorption, distribution, metabolism, and drug excretion. Children also have a longer expected period of exposure to immunosuppression, which can impact growth, risk of infection (bacterial, viral, and fungal), carcinogenesis, and likelihood of nonadherence. This review discusses immunosuppressive options for pediatric liver transplant recipients and the unique issues that must be addressed when managing this population. Further advances in the field of tolerance and accommodation are needed to relieve the acute and cumulative burden of chronic immunosuppression in children. Liver Transplantation 23 244–256 2017 AASLD.

Original languageEnglish (US)
Pages (from-to)244-256
Number of pages13
JournalLiver Transplantation
Volume23
Issue number2
DOIs
StatePublished - Feb 1 2017
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

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