title: Immunosuppression in infants with short bowel syndrome undergoing isolated liver transplantation.
abstract: BACKGROUND
  Little data exist on immunosuppressive drug absorption in children with short bowel syndrome and intestinal failure associated liver disease (SBS-IFALD).
  
  
  OBJECTIVE
  To evaluate the absorption of immunosuppressive medications in children with SBS-IFALD undergoing isolated liver transplantation (iLTx).
  
  
  METHODS
  A retrospective review was performed in children with SBS-IFALD undergoing LTx and comparison made with weight, age-matched children undergoing iLTX (extra-hepatic biliary atresia (EHBA) and normal intestinal length and function).
  
  
  RESULTS
  Seven children with SBS-IFALD undergoing iLTx (median residual bowel length, 60 cm, range 40-80) were compared with 15 children undergoing LTx for EHBA. SBS-IFALD children had significantly lower trough tacrolimus levels at three months (5.8 vs. 7.9 ng/mL, p<0.05) and six months (5.0 vs. 8.0 ng/mL, p<0.05), but equivalent levels at 12 months after iLTx. The median calculated dose-normalized concentrations indicated that systemic availability of tacrolimus was comparable in two groups at 3, 6, 12 months (33.1 vs. 23.3; 42.4 vs. 36; 51 vs. 52.9) despite the differences in enteral function. The incidence of acute rejection was 1/7 (SBS-IFALD) and 10/15 (EHBA) group (p = 0.06).
  
  
  CONCLUSIONS
  Children with SBS-IFALD demonstrated adequate absorption of oral tacrolimus without significant acute rejection rate after iLTx suggesting that modification of immunosuppression is not necessary.
authors.affiliation: The Liver Unit, Birmingham Children's Hospital (BCH), Birmingham, UK. Dominic.Dell-Olio@bch.nhs.uk
authors.forename: Dominic Dell
authors.initials: DD
authors.lastname: Olio
authors.forename: Girish
authors.initials: G
authors.lastname: Gupte
authors.forename: Khalid
authors.initials: K
authors.lastname: Sharif
authors.forename: M S
authors.initials: MS
authors.lastname: Murphy
authors.forename: Carla
authors.initials: C
authors.lastname: Lloyd
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McKiernan
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Kelly
authors.forename: Susan V
authors.initials: SV
authors.lastname: Beath
mesh_terms: D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000601:surgery*; D018709:Statistics, Nonparametric; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D011239:Prednisolone; D016559:Tacrolimus; D008775:Methylprednisolone