Beyond five years: Long-term follow-up in pediatric liver transplantation

Abstract

Pediatric liver transplant patients are now routinely surviving 10 years or more. Beyond the first year after transplant, surgical biliary or vascular complications are rare, and the incidence of acute rejection episodes falls precipitously. Attention is turning to minimizing the toxicity of immunosuppressive regimens and their potential negative impact on growth, bone health, cognitive development, renal function, and quality of life. Innovative combinations of immunosuppressive medications are being used as initial management after transplantation to minimize acute rejection and allow rapid weaning of corticosteroids and reduction in maintenance levels of calcineurin inhibitors. The substitution of potentially less toxic immunosuppressive agents, such as mycophenolate mofetil and rapamycin, is being studied in patients who develop renal dysfunction. A major current emphasis is on defining the natural history of long-term graft injury and elucidating histopathologic changes that mimic autoimmune chronic active hepatitis but are likely a form of chronic rejection due to production by the recipient of antibodies to foreign graft antigens. As patients survive longer, we are seeing various forms of immune dysregulation engendered by the presence of the graft and chronic immunosuppression of the host. By defining the resulting patterns of graft injury and understanding their immunopathogenesis, we can devise rational adjustments in immunosuppression that will preserve graft function and maximize graft life.

Neurocognitive outcomes at kindergarten entry after liver transplantation at <3 yr of age

“…This study is important for the variables that we did not find to be predictive as well as those uncovered. The neurotoxicity of calcineurin inhibitors has been described . It may have been that practice has changed from our previous experience where higher calcineurin levels related to lower VIQ .…”

The Design and Use of a Computerized Management of Follow-up Data for Liver Transplantation Patients

“…Doctors adjusted the drug use much easier according to patients' deserving curative effects and side-effects through recent follow-up visits [1]. It is also more efficient for doctors to acquire basic treatment information of patients such as the long-term effects of treatment, long-term complication and living time in order to screen treatments through long-term follow-up visits, and then to establish archives to find out the developmental rules of diseases which making for the medical science development [2]. Different from common patients, liver transplantation patients were always faced with rejection reaction, infection, and other potential complications, and they had to take immunosuppressant and anti-infective drugs all the time, that's the reason why they were required to be followed up whole life long [3,4].…”

Are children after liver transplant more prone to non‐alcoholic fatty liver disease?

“…As the excessive weight gain is common after liver transplantation and approximately two thirds become obese (11), it is reasonable to hypothesize that a possible cause of the occurrence/recurrence of post‐transplant NAFLD might be the post‐transplantation weight gain. Thus, it is the prevention and treatment of post‐liver transplant obesity, as well as other complications, which requires careful screening, correction of component of the metabolic syndrome, especially weight management, and long‐term surveillance to minimize the development of NAFLD/NASH (12, 13). A recent case report in the Journal highlights the recurrence of NASH after LT in a 13‐yr‐old boy (14).…”