Immunosuppression in pediatric liver transplant recipients: Unique aspects
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...
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| Published in | Liver transplantation Vol. 23; no. 2; pp. 244 - 256 |
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| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
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United States
Wiley Subscription Services, Inc
01.02.2017
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| Online Access | Get full text |
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| 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 |
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| AbstractList | 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. 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 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 |
| Author | Hewitt, Winston Miloh, Tamir Wheeler, Justin Sanchez, Christine Barton, Andrea Bulut, Pinar Keegan, Tara Goss, John Pham, Yen |
| Author_xml | – sequence: 1 givenname: Tamir surname: Miloh fullname: Miloh, Tamir email: tamir.miloh@bcm.edu organization: Texas Children's Hospital and Baylor College of Medicine – sequence: 2 givenname: Andrea surname: Barton fullname: Barton, Andrea organization: Texas Children's Hospital and Baylor College of Medicine – sequence: 3 givenname: Justin surname: Wheeler fullname: Wheeler, Justin organization: Cincinnati Children's Hospital – sequence: 4 givenname: Yen surname: Pham fullname: Pham, Yen organization: Texas Children's Hospital and Baylor College of Medicine – sequence: 5 givenname: Winston surname: Hewitt fullname: Hewitt, Winston organization: Phoenix Children's Hospital – sequence: 6 givenname: Tara surname: Keegan fullname: Keegan, Tara organization: Jackson Memorial Hospital – sequence: 7 givenname: Christine surname: Sanchez fullname: Sanchez, Christine organization: Phoenix Children's Hospital – sequence: 8 givenname: Pinar surname: Bulut fullname: Bulut, Pinar organization: Phoenix Children's Hospital – sequence: 9 givenname: John surname: Goss fullname: Goss, John organization: Texas Children's Hospital and Baylor College of Medicine |
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Long‐term medical management of the pediatric patient after liver transplantation: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation publication-title: Liver Transpl doi: 10.1002/lt.23697 – volume: 274 start-page: 35 year: 1995 ident: lt24677-bib-0004-20240115 article-title: Systems analysis of adverse drug events. ADE Prevention Study Group publication-title: JAMA doi: 10.1001/jama.1995.03530010049034 – volume: 17 start-page: S13 issue: suppl 3 year: 2011 ident: lt24677-bib-0012-20240115 article-title: Immunosuppression in pediatric liver transplantation: are little people different? publication-title: Liver Transpl |
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| Snippet | Pediatric liver transplantation has experienced improved outcomes over the last 50 years. This can be attributed in part to establishing optimal use of... |
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| SubjectTerms | Adolescent Adult Age Factors Child Communicable Diseases - epidemiology Communicable Diseases - etiology Communicable Diseases - immunology Counseling End Stage Liver Disease - mortality End Stage Liver Disease - surgery Graft Rejection - immunology Graft Rejection - prevention & control Graft Survival - immunology Humans Immune Tolerance Immunosuppression - adverse effects Immunosuppression - methods Immunosuppressive Agents - pharmacology Immunosuppressive Agents - therapeutic use Liver Liver - immunology Liver Transplantation - adverse effects Patient Compliance - psychology Patient Transfer Pediatrics Transplant Recipients - psychology Transplants & implants Treatment Outcome |
| Title | Immunosuppression in pediatric liver transplant recipients: Unique aspects |
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