Each year in the United Kingdom approximately 240 children benefit from solid organ transplantation.¹ Eleven paediatric centres variously perform kidney, heart, lung, liver and small bowel transplant operations. With current survival data approaching 90% or better at one year for most paediatric transplants, it is probable that at some point, these children will present to their local hospital or general practitioner (GP) for management of non-transplant issues or for shared care. Long term health and survival is dependent on careful adjustment of life long immunosuppressant medication. All of these children will be discharged from hospital on a combination of immunosuppression medications. The aim of immunosuppression is to prevent acute rejection, using a combination of drugs, while avoiding infection and toxicity. The combination of drugs (type and number) will depend on the organ transplanted, the time post-transplant, the patient’s rejection history, and side effects. There is no “one size fits all” immunosuppression protocol. Drugs and doses are adjusted according to clinical need. Children are seen regularly by the transplant centre during the first three months post-transplant, during which time most will be stabilised on their medication. This article focuses on maintenance immunosuppression that paediatricians, GPs, nurses, and pharmacists may encounter while caring for children in hospital or in the community.

EVIDENCE IN SOLID ORGAN TRANSPLANTATION

In adult transplantation, there are many more randomised controlled trials (RCTs) published in the field of renal transplantation than there are in the other fields of transplantation. This is probably because enough kidney transplants are performed to recruit a sufficient number of patients to the trials. In heart transplantation, there are only four randomised controlled studies despite the first operations being done back in 1967. Drug immunosuppression protocols have evolved based on results seen in renal transplantation, and empirical observation. Generally, immunosuppression protocols include a calcineurin inhibitor, an anti-metabolite, and …