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While intensive immunosuppressive regimens (containing CsA, tacrolimus, MMF, and steroids) effectively reduce acute or chronic rejection, they can produce long\u2010term side effects including viral infection, renal dysfunction, hypertension, and stunting. The development of effective methods of diagnosis, prevention, and treatment of CMV means that this is no longer a significant cause of mortality, but morbidity remains high. In contrast, infection rates of EBV remain high in EBV\u2010negative pre\u2010transplant patients. However, pre\u2010emptive reduction of immunosuppression or treatment with rituximab or adoptive T\u2010cell therapy is effective in preventing\/treating post\u2010transplant lymphoproliferative disease. Recent protocols have concentrated on reducing CsA immunosuppression, to prevent unacceptable cosmetic effects, and to reduce the hypertension, hyperlipidemia, and nephrotoxicity. Both CsA and tacrolimus cause a 30% reduction in renal function, with 4\u20135% of patients developing severe chronic renal failure. The use of IL\u20102 inhibitors for induction therapy with low\u2010dose calcineurin inhibitors, in combination with renal\u2010sparing drugs such as MMF or sirolimus for maintenance immunosuppression, should prevent significant renal dysfunction in the future. The concept of steroid\u2010free immunosuppression with IL\u20102 inhibitors, tacrolimus, and MMF is an attractive option, which may reduce stunting and renal dysfunction. However, these regimens may be associated with the increased development of<jats:italic>de\u2010novo<\/jats:italic>autoimmune hepatitis in 2\u20133% of children. The most important challenge to long\u2010term survival in transplanted children is the management of non\u2010adherence and other adolescent issues, particularly when transferring to adult units, as this is the time when many successful transplant survivors lose their grafts.<\/jats:p>","DOI":"10.1111\/j.1399-3046.2006.00567.x","type":"journal-article","created":{"date-parts":[[2006,7,20]],"date-time":"2006-07-20T16:54:21Z","timestamp":1153414461000},"page":"712-720","source":"Crossref","is-referenced-by-count":65,"title":["Current issues in pediatric transplantation"],"prefix":"10.1111","volume":"10","author":[{"given":"D. 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