A specialist in pediatric transplantation for children facing liver and intestinal disease, Dr. Mazariegos discuss current practices. He explains

• how treatments can vary among the spectrum of ages and individual situations,
• advances that allow for a reduction of immunosuppressant drugs, including heightened monitoring abilities for asymptomatic viral biomarkers, and 
• challenges in recommending treatments with possible future advancements in mind.

Dr. George V. Mazariegos is the director of Pediatric Transplantation at Children's Hospital of Pittsburgh. He is an associate professor at the University of Pittsburgh in the departments of Surgery, Anesthesiology, and Critical Care Medicine. While he specializes in children with liver and intestinal disease, the center cares for all pediatric transplantation issues. He gives listeners an overview of transplantation history and explains the particular quality-of-life issues that involve pediatric patients.

He comments that most pediatric patients, about 95%, require lifelong immunosuppression; a big focus of his research is understanding why that 5% doesn't need those drugs and what we can learn from them. Dr. Mazariegos explains that advances in viral detection and other monitoring tools have made it possible to reduce the amount of drugs patients need to take to the bare minimum. Therefore, they've been able to monitor the side effects and adjust the dosing before complications become significance. He adds a summary of the ways these drugs would change according to life stages various patients face.

Finally, he addresses the near-term future of his field, describing the challenge of trying to balance what's "around the corner" with what doctors can and should proceed with for now. For example, gene therapies have been touted as "just around the corner" for 20 years. Therefore, while gene therapy is very promising as half these kids suffer from a genetic condition, it isn't a usable treatment yet. While there has been progress in the delivery of the gene vector, the efficacy hasn't been proven.

For more, see his information page at https://www.chp.edu/find-a-doctor/service-providers/george-mazariegos-519, follow him on Twitter with @CHPtransplant, and email him through his CHP web site information page. He's Happy to chat with parents and patients.