Long term management of liver transplant rejection in children

George V. Mazariegos, Alcides A. Salzedas, Joseph Zavatsky, Rakesh Sindhi, Maria Parizhskaya, William McGhee, Ashokkumar Jain, Jorge Reyes

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

The current management of hepatic allograft rejection after liver transplantation in children requires effective baseline immunosuppression to prevent rejection and rapid diagnosis and treatment to manage acute rejection episodes. The subsequent impact on chronic rejection is dependent on the combination of adequate prevention and the treatment of acute rejection. Tacrolimus is a macrolide lactone that inhibits the signal transduction of interleukin-2 (IL-2) via calcineurin inhibition. Introduced in 1989, tacrolimus was first used in the salvage of refractory acute or chronic rejection under, cyclosporin or to rescue patients with significant cyclosporin-related complications. The majority of paediatric transplant centres use a combination of steroids with tacrolimus as a basic immunosuppressant regimen following paediatric liver transplantation. This combination has allowed the acute cellular rejection-free rate to increase to between 30 and 60%, while lowering the rate of refractory rejection to less than 5%. Corticosteroid-resistant rejection is commonly treated with monoclonal (muromonab CD3) or polyclonal preparations. Although most episodes of acute cellular rejection occur during the first 6 weeks after liver transplant, the appearance of late acute liver allograft rejection must raise the question of noncompliance, especially in the adolescent population. Chronic rejection is becoming increasingly rare under tacrolimus-based immunosuppression. Tacrolimus is effective in reversing refractory acute cellular rejection or early chronic rejection in patients initially treated with cyclosporin-based regimens. Patients with a history of noncompliance as well as children with auto-immune liver disease are at risk of chronic rejection. Retransplantation therapy for chronic rejection has, fortunately, become more rare in the tacrolimus era with only 3% of retransplants being performed for this indication. Newer immunosuppressive agents are further modifying the long term management of liver allograft rejection. These include mycophenolate mofetil, rapamycin and IL-2 antibodies such as daclizumab. The development of these agents is allowing patient-specific immunosuppressive management to minimise rejection as well as the complications related to immunosuppression.

Original languageEnglish (US)
Pages (from-to)31-48
Number of pages18
JournalBioDrugs
Volume14
Issue number1
DOIs
StatePublished - Jan 1 2000

Fingerprint

Graft Rejection
Tacrolimus
Liver
Immunosuppressive Agents
Immunosuppression
Cyclosporine
Allografts
Liver Transplantation
Interleukin-2
Pediatrics
Mycophenolic Acid
Transplants
Muromonab-CD3
Calcineurin
Immune System Diseases
Macrolides
Lactones
Sirolimus
Liver Diseases
Signal Transduction

All Science Journal Classification (ASJC) codes

  • Biotechnology
  • Pharmacology
  • Pharmacology (medical)

Cite this

Mazariegos, G. V., Salzedas, A. A., Zavatsky, J., Sindhi, R., Parizhskaya, M., McGhee, W., ... Reyes, J. (2000). Long term management of liver transplant rejection in children. BioDrugs, 14(1), 31-48. https://doi.org/10.2165/00063030-200014010-00004
Mazariegos, George V. ; Salzedas, Alcides A. ; Zavatsky, Joseph ; Sindhi, Rakesh ; Parizhskaya, Maria ; McGhee, William ; Jain, Ashokkumar ; Reyes, Jorge. / Long term management of liver transplant rejection in children. In: BioDrugs. 2000 ; Vol. 14, No. 1. pp. 31-48.
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Mazariegos, GV, Salzedas, AA, Zavatsky, J, Sindhi, R, Parizhskaya, M, McGhee, W, Jain, A & Reyes, J 2000, 'Long term management of liver transplant rejection in children', BioDrugs, vol. 14, no. 1, pp. 31-48. https://doi.org/10.2165/00063030-200014010-00004

Long term management of liver transplant rejection in children. / Mazariegos, George V.; Salzedas, Alcides A.; Zavatsky, Joseph; Sindhi, Rakesh; Parizhskaya, Maria; McGhee, William; Jain, Ashokkumar; Reyes, Jorge.

In: BioDrugs, Vol. 14, No. 1, 01.01.2000, p. 31-48.

Research output: Contribution to journalReview article

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AU - Mazariegos, George V.

AU - Salzedas, Alcides A.

AU - Zavatsky, Joseph

AU - Sindhi, Rakesh

AU - Parizhskaya, Maria

AU - McGhee, William

AU - Jain, Ashokkumar

AU - Reyes, Jorge

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N2 - The current management of hepatic allograft rejection after liver transplantation in children requires effective baseline immunosuppression to prevent rejection and rapid diagnosis and treatment to manage acute rejection episodes. The subsequent impact on chronic rejection is dependent on the combination of adequate prevention and the treatment of acute rejection. Tacrolimus is a macrolide lactone that inhibits the signal transduction of interleukin-2 (IL-2) via calcineurin inhibition. Introduced in 1989, tacrolimus was first used in the salvage of refractory acute or chronic rejection under, cyclosporin or to rescue patients with significant cyclosporin-related complications. The majority of paediatric transplant centres use a combination of steroids with tacrolimus as a basic immunosuppressant regimen following paediatric liver transplantation. This combination has allowed the acute cellular rejection-free rate to increase to between 30 and 60%, while lowering the rate of refractory rejection to less than 5%. Corticosteroid-resistant rejection is commonly treated with monoclonal (muromonab CD3) or polyclonal preparations. Although most episodes of acute cellular rejection occur during the first 6 weeks after liver transplant, the appearance of late acute liver allograft rejection must raise the question of noncompliance, especially in the adolescent population. Chronic rejection is becoming increasingly rare under tacrolimus-based immunosuppression. Tacrolimus is effective in reversing refractory acute cellular rejection or early chronic rejection in patients initially treated with cyclosporin-based regimens. Patients with a history of noncompliance as well as children with auto-immune liver disease are at risk of chronic rejection. Retransplantation therapy for chronic rejection has, fortunately, become more rare in the tacrolimus era with only 3% of retransplants being performed for this indication. Newer immunosuppressive agents are further modifying the long term management of liver allograft rejection. These include mycophenolate mofetil, rapamycin and IL-2 antibodies such as daclizumab. The development of these agents is allowing patient-specific immunosuppressive management to minimise rejection as well as the complications related to immunosuppression.

AB - The current management of hepatic allograft rejection after liver transplantation in children requires effective baseline immunosuppression to prevent rejection and rapid diagnosis and treatment to manage acute rejection episodes. The subsequent impact on chronic rejection is dependent on the combination of adequate prevention and the treatment of acute rejection. Tacrolimus is a macrolide lactone that inhibits the signal transduction of interleukin-2 (IL-2) via calcineurin inhibition. Introduced in 1989, tacrolimus was first used in the salvage of refractory acute or chronic rejection under, cyclosporin or to rescue patients with significant cyclosporin-related complications. The majority of paediatric transplant centres use a combination of steroids with tacrolimus as a basic immunosuppressant regimen following paediatric liver transplantation. This combination has allowed the acute cellular rejection-free rate to increase to between 30 and 60%, while lowering the rate of refractory rejection to less than 5%. Corticosteroid-resistant rejection is commonly treated with monoclonal (muromonab CD3) or polyclonal preparations. Although most episodes of acute cellular rejection occur during the first 6 weeks after liver transplant, the appearance of late acute liver allograft rejection must raise the question of noncompliance, especially in the adolescent population. Chronic rejection is becoming increasingly rare under tacrolimus-based immunosuppression. Tacrolimus is effective in reversing refractory acute cellular rejection or early chronic rejection in patients initially treated with cyclosporin-based regimens. Patients with a history of noncompliance as well as children with auto-immune liver disease are at risk of chronic rejection. Retransplantation therapy for chronic rejection has, fortunately, become more rare in the tacrolimus era with only 3% of retransplants being performed for this indication. Newer immunosuppressive agents are further modifying the long term management of liver allograft rejection. These include mycophenolate mofetil, rapamycin and IL-2 antibodies such as daclizumab. The development of these agents is allowing patient-specific immunosuppressive management to minimise rejection as well as the complications related to immunosuppression.

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Mazariegos GV, Salzedas AA, Zavatsky J, Sindhi R, Parizhskaya M, McGhee W et al. Long term management of liver transplant rejection in children. BioDrugs. 2000 Jan 1;14(1):31-48. https://doi.org/10.2165/00063030-200014010-00004