Immunosuppression in Pediatric Liver and Intestinal Transplantation: A Closer Look at the Arsenal

Al–Hussaini, Abdulrahman; Tredger, J. Michael; Dhawan, Anil

doi:10.1097/01.mpg.0000172260.46986.11

Cited by 14 publications

(12 citation statements)

References 164 publications

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“…Of relevance to these data is the development and increasing use of newer, often more potent immunosuppressive regimens (12)(13)(14)(15)(16)(17)(18), for example induction agents, poly-or monoclonal antibodies, mycophenylate and sirolimus. It is unfortunate that most studies that use these newer agents often initially emphasize attaining an almost zero rejection rate, but have not included a detailed evaluation of infection risk (15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Rejection and Infection in Pediatric Liver Transplantation

Shepherd

Turmelle

Nadler

et al. 2008

American Journal of Transplantation

135

105

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Rejection and infection are important adverse events after pediatric liver transplantation, not previously subject to concurrent risk analysis. Of 2291 children (<18 years), rejection occurred at least once in 46%, serious bacterial/fungal or viral infections in 52%. Infection caused more deaths than rejection (5.5% vs. 0.6% of patients, p < 0.001). Early rejection (<6 month) did not contribute to mortality or graft failure. Recurrent/chronic rejection was a risk in graft failure, but led to retransplant in only 1.6% of first grafts. Multivariate predictors of bacterial/fungal infection included recipient age (highest in infants), race, donor organ variants, bilirubin, anhepatic time, cyclosporin (vs. tacrolimus) and era of transplant (before 2002 vs. after 2002); serious viral infection predictors included donor organ variants, rejection, Epstein-Barr Virus (EBV) naivety and era; for rejection, predictors included age (lowest in infants), primary diagnosis, donor-recipient blood type mismatch, the use of cyclosporin (vs. tacrolimus), no induction and era. In pediatric liver transplantation, infection risk far exceeds that of rejection, which causes limited harm to the patient or graft, particularly in infants. Aggressive infection control, attention to modifiable factors such as pretransplant nutrition and donor organ options and rigorous age-specific review of the risk/benefit of choice and intensity of immunosuppressive regimes is warranted.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Rejection and Infection in Pediatric Liver Transplantation

Shepherd

Turmelle

Nadler

et al. 2008

American Journal of Transplantation

135

105

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“…On the basis of the importance of T-cell immunity for proper B-cell regulation, we must consider the immunosuppressive regimen of a transplant recipient with AIHA [24,25] and sirolimus could be an alternative immunosuppressive agent in resistant patients.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune cytopaenia after paediatric intestinal transplantation: a case series

Arcos¹,

Ybarra²,

Ramos³

et al. 2010

Transplant International

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“…[17] Lifelong therapeutic monitoring of tacrolimus blood concentrations is required to regulate drug levels and dosage in order to avoid suboptimal concentrations leading to graft rejection, or toxic levels potentially leading to adverse effects, including Epstein-Barr virus-related PTLD and nephrotoxicity. As a result, a growing population is being managed with long-term immunosuppression after intestinal transplantation.…”

Section: Adverse Eventsmentioning

confidence: 99%

Intestinal Transplantation in Children

Nayyar

McGhee

Martin³

et al. 2011

Pediatric Drugs

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This review summarizes the outcomes and known adverse effects of current immunosuppression strategies in use in pediatric intestinal transplantation. Intestinal transplantation has evolved from an experimental therapy to a highly successful treatment for children with intestinal failure who have complications with total parenteral nutrition. Because of continued success with intestinal transplantation over the past decade, the focus of clinicians and researchers is shifting from short-term patient survival to optimizing long-term outcomes. Current 5-year patient and graft survival rates after intestinal transplantation are 58% and 40%, respectively, in the US; single centers have reported nearly 80% patient and 60% graft survival rates at 5 years. The immunosuppression strategy in intestinal transplantation includes a tacrolimus-based regimen, usually in conjunction with an antibody induction therapy such as rabbit-antithymocyte globulin, interleukin-2 receptor antagonists, or alemtuzumab. The use of these immunosuppressive regimens, along with improved medical and surgical care, has contributed significantly toward improved outcomes. Optimization of post-transplant immunosuppression strategies to reduce adverse effects while minimizing acute and chronic graft rejection is a strong clinical and research focus.

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Immunosuppression in Pediatric Liver and Intestinal Transplantation: A Closer Look at the Arsenal

Cited by 14 publications

References 164 publications

Risk Factors for Rejection and Infection in Pediatric Liver Transplantation

Risk Factors for Rejection and Infection in Pediatric Liver Transplantation

Autoimmune cytopaenia after paediatric intestinal transplantation: a case series

Intestinal Transplantation in Children

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