Evaluation of immune status in pediatric recipients of hepatic orthografts

Survival in children following hepatic transplantation is better than in adults. We evaluated the immunologic status of both pediatric and adult patients prior to and following transplantation, to determine if there were differences in immunologic status that might contribute to this phenomenon. Studies included determination of mononuclear cell subsets, including T cells, T helper cells, T suppressor cells, and monocytes. In addition, we evaluated immune function by studying in vitro immunoglobulin (Ig) synthesis. Following transplantation, the T8 (cytotoxic/suppressor) cells in pediatric patients did not decline, whereas in adults they did (P less than .05). In vitro Ig synthesis in both adult and pediatric patients declined following transplantation. By 4 weeks, the adult group had begun to recover, whereas in the pediatric group there was still significant suppression (P less than .05). These studies suggest that there is decreased immune function in children who are recipients of hepatic allografts. Such findings could contribute to better outcome of hepatic allografting in children.