Project 2: Optimal Immunosuppressive Regimen for Pediatric Liver Transplant Recipients




Ashok, Keshav
Gottumukkala, Ananya
Panesar, Meher
Song, Jessika (Jiayao)

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George Mason University

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Background: The main obstacle to success is transplant rejection and managing the side effects of immunosuppressive medications. Induction and maintenance types of immunosuppressive medications are used in transplants. Induction therapy is used temporarily, only immediately following transplantation while maintenance immunosuppressive drugs are started and given long-term. Maintenance therapy can involve the use of antibodies or higher doses of medications. The standard triple medication regimen usually consists of the combination of a calcineurin inhibitor, an antiproliferative agent and a corticosteroid. These have been found to be more effective in balancing the risks of suppressed immune system with the benefit of organ transplant. However, the immunological risks (driven by age, preconditions, and other factors) of the child/pediatric patient should be considered, and the immunosuppressive therapy should be followed by therapeutic drug monitoring. [1] A study conducted by Feng, Ekong & Lobritto (2012) reported that immunosuppression came with many toxic effects. Some of these include renal dysfunction, infection, metabolic perturbation, and malignancy [2]. To add on, Blondet, Healy & Hsu (2017) reported that the 2 most common immunosuppressants, tacrolimus and cyclosporine, were both known to have long-term side effects in children, which included nephrotoxicity, neurotoxicity, infection, and malignancy. Patient survival rates for pediatric liver transplant recipients after the use of immunosuppressive agents were 94% after one year, 91% after five years, and 88% after 10 years [3]. They also found that the side effects of immunosuppressive medications were severe in pediatric liver transplant recipients. Some immunosuppressive agents, such as tacrolimus, antithymocyte globulin, basiliximab, and others, might cause side effects including sensitivity, nausea, vomiting, diarrhea, high blood pressure, acne, abdominal pain, discomfort, mood swings and more. While immunosuppressants help with preventing rejection, it may be a challenge for pediatric patients since their reactions to the medications may be critical. Objective: The study investigated how transplant outcomes (graft failure and patient mortality) vary by induction immunosuppressive therapy among pediatric liver transplant recipients.