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 immuno- suppressive 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 chil- dren, adolescents and young adults submitted to chronic immunosup- pression. The long-term complications of immunosuppression admin- istered to transplant recipients include the adverse effects secondary to the depression of the immune system, the toxicities specifically relat- ed 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 paediatric liver trans- plantation.