Sirolimus in pediatric transplant recipients.
The side effects of calcineurin inhibitors (CI) have a unique spectrum in pediatric recipients of organ transplants. These include a lifelong risk of mortality due to sepsis, a nearly 5% risk of renal failure from protracted exposure to CI, and a significantly higher risk of posttransplant lymphoproliferative disorder (PTLD) when compared with adults (10% versus 2%). This led us to explore the use of the new antiproliferative immunosuppressant sirolimus (SRL) for rescue and primary immunosuppression in recipients of pediatric abdominal and thoracic organs at the Children's Hospital of Pittsburgh. Following initial success with SRL in 50 such children, we also explored its use for the elimination of tacrolimus (TAC) in patients experiencing toxicity and for maintenance immunosuppression in steroid-sparing regimens in liver transplantation. These early results suggest that sirolimus may hold promise as a primary immunosuppressive agent under defined protocol conditions. The salient features of our experience with SRL in over 85 children are summarized here.
Sindhi
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University of Pittsburgh, Department of Pediatric Transplantation, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. sindrk@chp.edu
D016026:Bone Marrow Transplantation / Q000276:immunology; D002648:Child; D003404:Creatinine / Q000097:blood; D016027:Heart Transplantation / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007422:Intestines / Q000637:transplantation; D016030:Kidney Transplantation / Q000276:immunology; D016031:Liver Transplantation / Q000276:immunology; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D014181:Transplantation Immunology; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D003404:Creatinine; D020123:Sirolimus