Current trends in immunosuppression in pediatric orthotopic liver transplantation

The availability of new immunosuppressive drugs during the last decade has fostered explosive growth in the field of transplantation. Specifically, the arrival of cyclosporine A and OKT3 has allowed the performance of liver transplantation in the pediatric population with one year survival rates of approximately 70%. Azathioprine and steroids are still used with cyclosporine A as part of triple immunosuppressive therapy. Each drug has its own array of side effects, although the triple regimen permits minimizing the dose (and hence the toxicity) of any single agent. Future directions for improvements in immunosuppression will include: 1) new drugs such a FK506 (which is currently undergoing a clinical trial in Pittsburg); and 2) the development of monoclonal antibodies to specific immune markers. These and other approaches may allow the development of transplant tolerance, ultimately rendering lifelong immunosuppression unnecessary.