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Considerations in children

Owing in part to successful long-term survival, the consequences of immunosuppression have gained wider attention from the transplant community. Both the micro-emulsified cyclosporine product and tacrolimus have been useful in decreasing rejection episodes and have been linked to decreased use of OKT-3. Each of these calcineurin inhibitors (tacrolimus and cyclosporine) has been associated with long-term consequences that have recently been brought to the forefront in pediatric transplantation. New immuno-suppressive agents are under investigation in the pediatric liver transplant recipient with attention directed toward trying to avoid these long-term complications of calcineurin inhibitors. Incorporation of mycophenolate with either tacrolimus or cyclosporine has become commonplace in the pediatric transplant community. Likewise, limiting calcineurin inhibitor exposure in pediatric patients has recently been demonstrated with induction protocols that have included the new mono-clonal antibodies to the CD-25 cell (Daclizumab and basiliximab). Steroid-sparing protocols are being investigated with an eye toward long-term outcomes with the hope of avoiding hypertension, diabetes, and growth. Other agents, such as sirolimus, are being evaluated for their usefulness in pediatric liver transplantation.