title: [Sirolimus for rescue of recurrent acute rejection and diabetes mellitus after liver transplantation: report of one case].
abstract: Sirolimus (SRL) is a new immunosuppressive drug approved for renal transplantation, but is being used increasingly in orthotopic liver transplantation (OLT). Compared with the calcineurin inhibitors, SRL has different mechanisms of action and side effects profile. Thus, this drug offers significant potential advantages over other immunosuppressive agents. SRL does not cause glucose intolerance, hypertension or renal failure, but it may cause dyslipidemia, hepatic artery thrombosis, thrombocytopenia, anemia, leukopenia, oral mucosa ulcers, edema, arthralgias and wound complications. SRL inhibits the signal of interleukin 2 at a post-receptor level, inhibiting lymphocyte proliferation and fibroblast proliferation. It also has antineoplastic and antifungal effects. We report a 10 years old girl who underwent OLT, experiencing a biopsy-proven recurrent acute rejection (AR) in spite of using three immunosuppressive agents (tacrolimus, mofetil micofenolate and steroids). She developed diabetes mellitus as a consequence of the immunosuppressive therapy. She was rescued with SRL, not experiencing AR again. Mofetil micofenolate, steroids and insulin could be discontinued and tacrolimus doses were reduced, without experiencing severe complications. SRL is a new and safe immunosuppressive agent for rescue in patients with OLT and recurrent AR.
authors.affiliation: Unidad de Trasplante, Clínica Alemana, Santiago, Chile. j.roque@entelchile.net
authors.forename: Jorge
authors.initials: J
authors.lastname: Roque
authors.forename: Gloria
authors.initials: G
authors.lastname: Ríos
authors.forename: Juan
authors.initials: J
authors.lastname: Hepp
authors.forename: Roberto
authors.initials: R
authors.lastname: Humeres
authors.forename: Horacio
authors.initials: H
authors.lastname: Ríos
authors.forename: José M
authors.initials: JM
authors.lastname: Herrera
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rius
mesh_terms: D002648:Child; D003920:Diabetes Mellitus / Q000139:chemically induced*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016031:Liver Transplantation; D020123:Sirolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus