Long-term complications of immunosuppression in pediatric liver recipients

Liver transplantation (LT) today constitutes a well-standardized and efficient therapy for children with acute and chronic hepatic failure. Appropriate pre-transplant management, organ preservation, adequate surgical techniques, and the progressive introduction of new immunosuppressive regimens have contributed to significantly improve, over the years, the general outcome after LT. Consequently, these good overall results has allowed the constitution of a growing cohort of children, adolescents and young adults submitted to chronic immunosuppression. The long-term complications of immunosuppression administered to transplant recipients include the adverse effects secondary to the depression of the immune system, the toxicities specifically related to the individual immunosuppressive drugs, and the sense of lack of rehabilitation for the transplant patient, with, secondarily, the question of non-adherence to the medications. This review will essentially focus on these three issues in the particular context of pediatric liver transplantation.