Journal List > J Korean Soc Transplant > v.25(3) > 1034341

J Korean Soc Transplant. 2011 Sep;25(3):165-168. Korean.
Published online September 30, 2011.  https://doi.org/10.4285/jkstn.2011.25.3.165
Copyright © 2011 The Korean Society for Transplantation
Issues on Long-term Management after Liver Transplantation in Children
Kyung Mo Kim, M.D.
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.

Corresponding author (Email: kmkim@amc.seoul.kr )
Received September 02, 2011; Accepted September 05, 2011.

Abstract

With advancements of liver transplantation, the patient's survival improved remarkably. Thus the long-term survivors are increasing especially for the pediatric liver transplantation recipients. Consequently they are facing the challenge of maintaining graft function while minimizing long-term complications. In this review, I will discuss calcineurin inhibitor toxicity, problems with steroid, adherence to medical regimen, posttransplant growth, chronic graft dysfunction, tolerance.

Keywords: Child; Liver transplantation; Postoperative complications; Medication adherence; Transplantation tolerance

Figures


Fig. 1
The overall rates of patient survival at two time period. Those before 2003 at 1 and 5 years were 86.4%, 79.5%, and 78.4%, respectively. Those after 2003 were 95.4% and 95.4%, respectively (P<0.05, Kaplan-Meier method). There is a statistically significant improvement in patient survival. Reprinted from reference [2].
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Fig. 2
Post-transplantation height mean standard deviation scores (zH) of children with retarded growth (•) and normal growth (▪) at time of transplantation. The height of growth-retarded children was restored by catch-up growth and nongrowth- retarded children grew adequately for up to 7 years. Adapted from reference [13].
Click for larger image

References
1. Starzl TE, Marchioro TL, Vonkaulla KN, Hermann G, Brittain RS, Waddell WR. Homotransplantation of the liver in humans. Surg Gynecol Obstet 1963;117:659–676.
2. Kim KM, Oh SH, Lee YJ, Kim T, Kim DY, Lee SG. Clinical experience of over 200 cases of pediatric liver transplantation in a single center: Improved patient survival. Liver Transpl 2011;17 Suppl 1:S233.
3. Devlin J, Williams R, Neuhaus P, McMaster P, Calne R, Pichlmayr R, et al. Renal complications and development of hypertension in the European study of FK 506 and cyclosporin in primary liver transplant recipients. Transpl Int 1994;7 Suppl 1:S22–S26.
4. Menegaux F, Keeffe EB, Andrews BT, Egawa H, Monge H, Concepcion W, et al. Neurological complications of liver transplantation in adult versus pediatric patients. Transplantation 1994;58:447–450.
5. Varo E, Padin E, Otero E, Tomé S, Castroagudin JF, Delgado M, et al. Cardiovascular risk factors in liver allograft recipients: relationship with immunosuppressive therapy. Transplant Proc 2002;34:1553–1554.
6. Allman SD, McWhorter AG, Seale NS. Evaluation of cyclosporin-induced gingival overgrowth in the pediatric transplant patient. Pediatr Dent 1994;16:36–40.
7. Al-Sinani S, Dhawan A. Corticosteroids usage in pediatric liver transplantation: To be or not to be!. Pediatr Transplant 2009;13:160–170.
8. Oh SH, Kim KM, Kim DY, Lee YJ, Rhee KW, Jang JY, et al. Long-term outcomes of pediatric living donor liver transplantation at a single institution. Pediatr Transplant 2010;14:870–878.
9. Cho JM, Kim KM, Oh SH, Lee YJ, Rhee KW, Yu E. De novo autoimmune hepatitis in Korean children after liver transplantation: A single institution's experience. Transplant Proc 2011;43:2394–2396.
10. Gras JM, Gerkens S, Beguin C, Janssen M, Smets F, Otte JB, et al. Steroid-free, tacrolimus-basiliximab immunosuppression in pediatric liver transplantation: clinical and pharmacoeconomic study in 50 children. Liver Transpl 2008;14:469–477.
11. Dew MA, Dabbs AD, Myaskovsky L, Shyu S, Shellmer DA, DiMartini AF, et al. Meta-analysis of medical regimen adherence outcomes in pediatric solid organ transplantation. Transplantation 2009;88:736–746.
12. Ekong UD, Bhagat H, Alonso EM. Once daily calcineurin inhibitor monotherapy in pediatric liver transplantation. Am J Transplant 2010;10:883–888.
13. Park SJ, Rim SH, Kim KM, Lee JH, Choi BH, Lee SY, et al. Long-term growth of pediatric patients following living-donor liver transplantation. J Korean Med Sci 2005;20:835–840.
14. Mazariegos GV, Reyes J, Marino IR, Demetris AJ, Flynn B, Irish W, et al. Weaning of immunosuppression in liver transplant recipients. Transplantation 1997;63:243–249.
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