Immunosuppression for Pediatric Liver Transplant Patients

Two areas of advancement for patients and families of children who are undergoing liver transplant recovery are immunologic testing and immunosuppression withdrawal. Both topics are described below.

What Is Immunosuppressive Therapy for Pediatric Liver Transplant?

Immunosuppressive therapy is medication that helps prevent your child’s body from rejecting its new liver — and it’s a critical step in pediatric liver transplant recovery.

Your child’s immune system is designed to identify and fight off foreign invaders, like bacteria, viruses, and cancer cells.

When your child receives a new liver, his or her body may detect that antigens on the organ’s cells do not match their own. This triggers an immune response that “attacks” the new liver and creates a variety of harmful side effects for your child.

To prevent this, doctors prescribe a series of immunosuppressive medications that slow the immune system’s response, so the liver can work properly.

What Do Immunosuppressive Drugs Do for Pediatric Liver Transplant Patients?

Immunosuppressive drugs suppress or weaken the immune system to minimize the body’s reaction to the new, foreign liver. These medications allow the liver to remain healthy, as well as minimize side effects.

  • Immunosuppressive drugs are only available through a doctor’s prescription.
  • They may come in the form of a liquid, tablet/capsule, or injection.
  • These drugs weaken the immune system and make patients more susceptible to infection and illness.
  • Regular testing is often needed to monitor the effectiveness of the drugs.
  • Talk to your doctor about side effects and infection prevention.

It is critical that patients on immunosuppressive drugs take their medications directly as prescribed each day — changes in the way they take the medication could trigger an immune response. Over time, doctors may adjust or change the type of medication your child takes.

New Immunologic Tests

With the help of investigators at the Hillman Center for Pediatric Transplantation and around the country, we have designed simple blood tests that may help determine why some patients need more immunosuppression and some need less.

These tests measure different immune cell types, the patient’s genetic ability to cause immune reactions, and the patient’s immune reactions to their new liver after a transplant procedure.

What is involved with these immunologic tests?

  • The tests need to be drawn at a visit in Pittsburgh, preferably Monday through Wednesday.
  • The blood tests can be drawn with your usual blood work.
  • We need at least three weeks notice prior to scheduling your tests.
  • These tests may be of benefit to all patients, both those who need less immunosuppression drugs as well as those who have needed more because of past rejection.

To participate, call your Children’s Hospital of Pittsburgh of UPMC liver transplant coordinator at 412-648-3200 and schedule a visit.

Post-Liver Transplant Immunosuppression Withdrawal

While some patients may require drug withdrawal due to infections or other emergency indications, other patients may be candidates for elective drug withdrawal after liver transplantation.

Immunosuppression is weaned as part of our ongoing clinical efforts to minimize the complications of immune suppressants. Weaning of immunosuppression is individually tailored to each patient.

What are the criteria for considering elective drug withdrawal?

  • Normal liver function
  • No history of autoimmune liver disease
  • Ability and willingness to obtain more frequent blood work after changes in immunosuppression
  • A liver biopsy may be recommended if there is significant change in liver numbers or at certain points in the drug withdrawal process

For more information, contact a Children’s Hospital liver transplant coordinator at 412-648-3200.

Learn more about Pediatric Liver Transplants at Children's Hospital of Pittsburgh of UPMC.