title: Immunosuppression in pediatric liver transplant recipients: Unique aspects.
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.
authors.affiliation: Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
authors.forename: Tamir
authors.initials: T
authors.lastname: Miloh
authors.affiliation: Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
authors.forename: Andrea
authors.initials: A
authors.lastname: Barton
authors.affiliation: Cincinnati Children's Hospital, Cincinnati, OH.
authors.forename: Justin
authors.initials: J
authors.lastname: Wheeler
authors.affiliation: Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
authors.forename: Yen
authors.initials: Y
authors.lastname: Pham
authors.affiliation: Phoenix Children's Hospital, Phoenix, AZ.
authors.forename: Winston
authors.initials: W
authors.lastname: Hewitt
authors.affiliation: Jackson Memorial Hospital, Miami, FL.
authors.forename: Tara
authors.initials: T
authors.lastname: Keegan
authors.affiliation: Phoenix Children's Hospital, Phoenix, AZ.
authors.forename: Christine
authors.initials: C
authors.lastname: Sanchez
authors.affiliation: Phoenix Children's Hospital, Phoenix, AZ.
authors.forename: Pinar
authors.initials: P
authors.lastname: Bulut
authors.affiliation: Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
authors.forename: John
authors.initials: J
authors.lastname: Goss
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D003141:Communicable Diseases / Q000453:epidemiology / Q000209:etiology / Q000276:immunology; D003376:Counseling; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods*; D007166:Immunosuppressive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D008099:Liver / Q000276:immunology; D016031:Liver Transplantation / Q000009:adverse effects*; D010349:Patient Compliance / Q000523:psychology; D010360:Patient Transfer; D066027:Transplant Recipients / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents