Long-term outcomes after liver transplantation in children

The goal of this review is to summarize new knowledge as it relates to adherence to medical regimen, posttransplant growth, posttransplant renal dysfunction and late allograft dysfunction in pediatric liver transplant recipients.

Nonadherence is perhaps the most important predictor of rejection episodes in long-term pediatric liver transplant survivors. Health-related quality of life may independently correlate with nonadherence to medical regimen. Nephrotoxicity related to calcineurin inhibitor use remains a frequent occurrence. Improved outcome will depend on trials that stratify immunosuppression based on the risk for development of posttransplant renal dysfunction. Among pediatric liver transplant recipients, late graft loss is uncommon, in part because most children do not undergo liver transplantation for diseases that recur in the allograft.

Liver transplant recipients and their families face the challenge of maintaining graft function while minimizing long-term immune and nonimmune complications related to immunosuppressive medications. Gaps in knowledge remain with respect to long-term outcomes in pediatric liver transplantation and research will require not only translational efforts and clinical trials but also longitudinal and long-term observational studies to permit the recognition of emerging trends as the cohort ages.