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Immunologic Response of the Child to Short- and Long-Term Immunosuppression

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Solid Organ Transplantation in Infants and Children

Part of the book series: Organ and Tissue Transplantation ((OTT))

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Abstract

Solid organ transplantation has become a proven and accepted therapy in pediatric patients with organ failure that is not only lifesaving but also greatly contributes to a better quality of life in organ recipients. This development was possible because of a remarkable expansion in the available repertoire of immunosuppressive medications. Over the past 30 years, however, despite considerable improvement in short-term outcomes, long-term allograft survival has only minimally improved. Chronic allograft dysfunction is the leading cause of allograft loss in pediatric organ transplant recipients. In addition, the consequences of the long-term use of immunosuppressive medications can be severe and include increased susceptibility to infection, drug toxicities, and the development of comorbid conditions such as chronic kidney disease, cardiovascular disease, and cancer. This chapter will review current immunosuppressive strategies used in solid organ transplantation with a particular focus on the immunologic response of pediatric patients to both short- and long-term immunosuppression strategies. Further research will hopefully provide us with newer strategies that promote immunologic tolerance of the transplanted organ without the severe side effects and with improved long-term allograft survival.

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Abbreviations

ACR:

acute cellular rejection

AMR:

Antibody-mediated rejection

APC:

Antigen-presenting cell

ATG:

Anti-thymocyte globulin

AV:

Allograft vasculopathy

CAD:

Chronic allograft dysfunction

CKD:

Chronic kidney disease

CMV:

Cytomegalovirus

CNI:

Calcineurin inhibitor

DSA:

Donor-specific antibodies

EBV:

Epstein-Barr virus

ESKD:

End-stage kidney disease

FKBP12:

FK506-binding protein12

HAT:

Hepatic artery thrombosis

IL-2:

Interleukin-2

IVIG:

Intravenous immune globulin

MMF:

Mycophenolate mofetil

6-MP:

6-mercaptopurine

MRI:

Magnetic resonance imaging

mTOR:

Mammalian targets of rapamycin

NFAT:

Nuclear factor of activated T-cells

NF-κB:

Nuclear factor kappa-light-chain-enhancer of activated B cells

NODAT:

New onset diabetes after transplantation

PPH:

Plasmapheresis

PRES:

Posterior reversible encephalopathy syndrome

PTLD:

Posttransplant lymphoproliferative disease

SOT:

Solid organ transplantation

TPMT:

Thiopurine S-methyltransferase

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Author information

Authors and Affiliations

  1. Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Deborah M. Consolini

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  1. Deborah M. Consolini
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Correspondence to Deborah M. Consolini .

Editor information

Editors and Affiliations

  1. Department of Surgery, Jefferson Medical College, Wilmington, Delaware, USA

    Stephen P. Dunn

  2. Division of Gastroenterology, Seattle Children’s Hospital, Seattle, Washington, USA

    Simon Horslen

Section Editor information

  1. Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Deborah M Consolini

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Consolini, D.M. (2018). Immunologic Response of the Child to Short- and Long-Term Immunosuppression. In: Dunn, S., Horslen, S. (eds) Solid Organ Transplantation in Infants and Children. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-07284-5_48

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  • DOI: https://doi.org/10.1007/978-3-319-07284-5_48

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07283-8

  • Online ISBN: 978-3-319-07284-5

  • eBook Packages: MedicineReference Module Medicine

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