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Safety and efficacy of tacrolimus in pediatric liver recipients
Author(s) -
Kelly Deirdre
Publication year - 2011
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2010.01437.x
Subject(s) - tacrolimus , medicine , immunosuppression , calcineurin , liver transplantation , adverse effect , quality of life (healthcare) , transplantation , intensive care medicine , nursing
Kelly D. Safety and efficacy of tacrolimus in pediatric liver recipients.
Pediatr Transplantation 2011: 15:19–24. © 2010 John Wiley & Sons A/S. Abstract: Pediatric liver transplantation is now so successful that we expect more than 80% of children to survive into adolescence and adulthood. As the focus of care shifts toward long‐term patient management, immunosuppressive regimens should, in addition to preventing acute and chronic rejection, promote good quality of life and be free of significant long‐term side effects. Historically, the most effective immunosuppressive regimens have been based on induction with a combination of calcineurin inhibitors (cyclosporin or tacrolimus) and steroids. Usually, maintenance is monotherapy with cyclosporin or tacrolimus or dual therapy with low‐dose alternate‐day steroids to encourage growth. A number of studies, including long‐term follow‐up, have shown significantly lower incidences of rejection, hypertension, hyperlipidemia and cosmetic side effects in patients treated initially with tacrolimus compared with cyclosporin. The use of anti‐interleukin‐2 inhibitors as induction therapy, with low‐dose tacrolimus or in combination with mycophenolate mofetil, has a key role in preventing significant renal dysfunction and reducing infection and rejection. Steroid‐free immunosuppression is also proving to be an effective option for the management of pediatric liver recipients. The main challenges now facing pediatricians include ensuring long‐term quality of life, optimizing immunosuppression while preventing associated adverse events, and managing a smooth transition from childhood to adolescence and adulthood.