Pediatric liver transplantation: Part II. Managing the long-term complications.

ABSTRACT

Increasing numbers of children are receiving liver transplants at major centers and returning to their home hospitals for long-term follow-up. This review summarizes the long-term complications in pediatric liver transplant recipients and their recognition and management. Emphasis is placed on an understanding of the practical aspects of the pharmacokinetics and toxicity of cyclosporine, the major immunosuppressive drug used in these patients. Common infectious problems, particularly serious viral infections, are reviewed with their unique clinical presentations in this immunocompromised population. Therapeutic alternatives for episodes of acute rejection are offered to facilitate communication with the transplant center and familiarize the local pediatric gastroenterologist and his or her staff with the management issues facing those who take care of these complex patients.