title: Towards minimizing immunosuppression in pediatric liver transplant recipients.
abstract: Immunosuppression regimens after liver transplantation focus mainly on preventing rejection and subsequent graft loss. However, in children, morbidity and mortality rates from infections exceed those from rejection after transplant, and immunosuppression can hinder growth, renal function, and graft tolerance. We hypothesized that early steroid withdrawal, with a primary aim of TAC monotherapy would yield no penalty in terms of rejection and graft loss, while reducing risks of infection and maximizing growth. We prospectively evaluated 64 consecutive pediatric liver transplant recipients. One yr patient/graft survival was 93/90%, respectively. At one yr post-transplant, 75.4% of patients were on TAC monotherapy. No deaths or graft losses were caused by infection. Sixty-one percent of patients had at least one episode of rejection, most within three months following transplant and 3.8% were treated for chronic rejection. One non-compliant adolescent died from chronic rejection. CMV, EBV, and lymphoproliferative disease rates were 3.1%, 5.3%, 1.8%, respectively. Pretransplant and one yr post-transplant glomerular filtration rates were unchanged. One yr improved catch-up growth was observed. We conclude that immunosuppression minimization after pediatric liver transplant yields no serious complications from rejection, and might confer advantages with respect to infection, renal function, growth, and is deserving of wider application and study.
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Washington University School of Medicine, St Louis, MO, USA. turmelle_y@kids.wustl.edu
authors.forename: Yumirle P
authors.initials: YP
authors.lastname: Turmelle
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Nadler
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Anderson
authors.forename: Maria B
authors.initials: MB
authors.lastname: Doyle
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Lowell
authors.forename: Ross W
authors.initials: RW
authors.lastname: Shepherd
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008107:Liver Diseases / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008232:Lymphoproliferative Disorders / Q000517:prevention & control; D008297:Male; D011446:Prospective Studies; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids