A study of craniofacial growth in infant heart transplant recipients receiving cyclosporine

Niles, David G; Rynearson, R.David; Baum, Marti; Neufeld, Roland D.W; Caruso, Joseph M.

doi:10.1016/s1053-2498(99)00141-2

Cited by 15 publications

(9 citation statements)

References 20 publications

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“…It is difficult for teenagers to accept the weight gain and cushingoid features secondary to steroids, or the hirsutism and gingival hyperplasia associated with CsA. In addition, for those teenagers transplanted as infants, the gingival hyperplasia secondary to CsA may induce leonine facial features (78).…”

Section: Adolescent Issuesmentioning

confidence: 99%

Current issues in pediatric transplantation

Kelly

2006

Pediatric Transplantation

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Pediatric solid organ transplantation is so successful that >80% of children will survive to become teenagers and adults. Therefore, it is essential that these children maintain a good quality life, free of significant long-term side effects. While intensive immunosuppressive regimens (containing CsA, tacrolimus, MMF, and steroids) effectively reduce acute or chronic rejection, they can produce long-term side effects including viral infection, renal dysfunction, hypertension, and stunting. The development of effective methods of diagnosis, prevention, and treatment of CMV means that this is no longer a significant cause of mortality, but morbidity remains high. In contrast, infection rates of EBV remain high in EBV-negative pre-transplant patients. However, pre-emptive reduction of immunosuppression or treatment with rituximab or adoptive T-cell therapy is effective in preventing/treating post-transplant lymphoproliferative disease. Recent protocols have concentrated on reducing CsA immunosuppression, to prevent unacceptable cosmetic effects, and to reduce the hypertension, hyperlipidemia, and nephrotoxicity. Both CsA and tacrolimus cause a 30% reduction in renal function, with 4-5% of patients developing severe chronic renal failure. The use of IL-2 inhibitors for induction therapy with low-dose calcineurin inhibitors, in combination with renal-sparing drugs such as MMF or sirolimus for maintenance immunosuppression, should prevent significant renal dysfunction in the future. The concept of steroid-free immunosuppression with IL-2 inhibitors, tacrolimus, and MMF is an attractive option, which may reduce stunting and renal dysfunction. However, these regimens may be associated with the increased development of de-novo autoimmune hepatitis in 2-3% of children. The most important challenge to long-term survival in transplanted children is the management of non-adherence and other adolescent issues, particularly when transferring to adult units, as this is the time when many successful transplant survivors lose their grafts.

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Section: Adolescent Issuesmentioning

confidence: 99%

Current issues in pediatric transplantation

Kelly

2006

Pediatric Transplantation

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“…In addition, for those teenagers who underwent a transplant as infants, the gingival hyperplasia secondary to cyclosporine may have induced leonine facial features. [8] …”

Section: Psychologic Issuesmentioning

confidence: 99%

Strategies for Optimizing Immunosuppression in Adolescent Transplant Recipients

Kelly

2003

Pediatric Drugs

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Adolescence is a difficult time for transplant recipients; they must learn to take responsibility for their own behavior and medication, and to balance their developing sexuality in a body that has been transformed by the adverse effects of immunosuppression. More than 80% of children survive transplantation to adolescence and adulthood, thus long-term outcome and tailoring of immunosuppression is of great importance. To date, the most experience with long-term immunosuppression regimens is cyclosporine, which is well tolerated and effective. Long-term adverse effects include hypertension, nephrotoxicity, and post-transplant lymphoproliferative disease (PTLD). The recent development of tacrolimus has improved the cosmetic adverse effects related to cyclosporine, but has similar rates of hypertension and nephrotoxicity, and possibly a higher rate of PTLD. There has been a recent, welcome development in renal sparing drugs, such as mycophenolate mofetil, which has no cosmetic adverse effects, does not require drug level monitoring and is thus particularly attractive to teenagers. Recent surveys demonstrate recovery of renal function with mycophenolate mofetil, if started prior to irreversible renal dysfunction. There are currently little published data on the use of sirolimus (rapamycin) in the pediatric population, but preliminary studies suggest that the future use of interleukin-2 receptor antibodies may be beneficial for immediate post-transplant induction of immunosuppression. It is important when planning immunosuppression for adolescents to consider the effects of drug therapy on both males and females in order to maintain fertility and to ensure safety in pregnancy. Noncompliance is a problem in this age group, but adequate practical measures and support should reduce noncompliance, and allow good, long-term graft function.

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“…Conclusions: These results led us to conclude that some cephalometric measurements of HIV-positive children and adolescents may be similar to those of normoreactive subjects. (Am J Orthod Dentofacial Orthop 2018;153: [26][27][28][29][30][31][32][33][34][35] W ith the implementation of highly active antiretroviral therapy (HAART) in the 1990s, patients with human immunodeficiency virus (HIV1) experienced a significant increase in their quality and expectation of life. But in a short while, the adverse effects of the combination of antiretroviral drugs began to be identified through the compromised physiologic functions in several systems and organs.…”

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confidence: 99%

“…Several studies have demonstrated the capacity of medications and chronic systemic diseases to lead to changes in craniofacial growth and development. [23][24][25][26][27][28][29][30][31] However, no such studies of HIV/AIDS patients were found; therefore, there is no way to estimate whether the disease or its treatment can influence craniofacial growth.…”

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confidence: 99%