Medications After Pediatric Liver Transplant
Your child's body will respond to the new liver as a foreign body and will try to reject it. To prevent this, she'll be placed on antirejection medications (medications that suppress the immune system) after the operation and is expected to continue to take them for the rest of his or her life.
Antirejection medications have a variety of potential side effects. Children taking these medications may have increased risk of certain infections. In addition, the medications may cause kidney function changes, high blood pressure, and may interact with other medicines (like common antibiotics). For these reasons your child will be prescribed other medications to counteract those effects as needed.
Your child's medication dosages may change frequently, especially in the first few weeks or months after transplant, depending upon her response to them. Your child's doctor will order periodic blood tests to measure the medication amount in her body and ensure she doesn't get too much or too little.
To prevent his body from rejecting the new liver, your child must take antirejection medications starting immediately after liver transplant and continuing for the rest of his life. In the first year, your child will take higher doses of these drugs, as well as a variety of other medications, such as antibiotics and antifungals. As time progresses, the dosages and number of medications will decrease. Your child may be taking one or more of the following antirejection medications (also called immunosuppressants):
- Tacrolimus (brand name: PROGRAF) is taken in the morning and at night, with 12 hours between each dose, at the same times every day. The doctor determines the tacrolimus dosage based on liver enzymes and blood levels.
- Cyclosporine (brand names: NEORAL, GENGRAF) is taken in the morning and at night, with 12 hours between each dose. Dosage is individually regulated based on the amount of cyclosporine in your child's bloodstream.
- Prednisone/prednisolone (brand names: SOLU-MEDROL, PEDIAPRED, PRELONE), steroids are given once a day in the morning. Your child's dosage will be decreased over a period of three to six months and eventually discontinued.
- Mycophenolate mofetil (brand name: CELLCEPT), used in combination with Prograf and prednisone, is taken morning and night, with 12 hours between each dose, at the same times every day.
- Sirolimus (brand name: RAPAMUNE), is taken once a day. The doctor determines the Sirolimus dosage based on the amount in your child's bloodstream.
Your child's healthcare team will periodically check your child to determine the level of medication in his bloodstream. Blood samples should be collected in the morning before the AM dose.
When giving your child immunosuppressants, you must give them exactly as directed by the doctor. If you have any questions, be sure to talk to your child's healthcare team.
Your child's doctor will probably prescribe other medications in addition to the antirejection medications your child is taking.
Because antirejection medications affect the immune system, children who receive a liver transplant will be at higher risk for infections, so your child will also need to take drugs designed to prevent them:
- Cotrimoxazole (brand names: BACTRIM, SEPTRA) — antibiotic designed to prevent pneumocystic pneumonia — it is taken once or twice a day on Mondays, Wednesdays and Fridays generally for one year after transplant.
- Nystatin (brand name: MYCOSTATIN), an antifungal medication used to prevent thrush (a fungal infection that causes white patches in the mouth), is taken four times a day. Your child should swish the liquid in her mouth, then swallow it. Nystatin is stopped around the same time as prednisone.
- Ganciclovir (brand name: CYTOVENE), an antiviral medication that is given intravenously to prevent and treat cytomegalovirus (CMV), will be given to your child once a day while she is in the hospital; she may continue to take it after discharge.
- Acyclovir (brand name: ZOVIRAX), the oral version of ganciclovir, is taken three times a day for 100 days after the transplant.
In addition to infection-fighting drugs, your child may also be taking other medicines and supplements:
- Aspirin, taken once a day in the morning, prevents blood clots from forming in the liver's blood vessels. Your child will be on aspirin until the one-year anniversary of her transplant.
- Ranitidine (brand name: ZANTAC), taken in conjunction with steroids, to help prevent stomach irritation.
- Magnesium supplements, usually taken two to four times a day, may occasionally be prescribed, because sometimes antirejection medications can cause the body to "waste" magnesium, lowering your child's magnesium levels.
- Calcium supplements may occasionally be prescribed if your child has low bone density because of her liver disease or medications.
- Ursodiol (brand name: ACTIGALL), usually taken two times a day, helps to increase bile flow.
Reviewed by: Elizabeth B. Rand, MD
Date: November 2012