Sirolimus in pediatric liver transplantation: a single-center experience.
OBJECTIVE
Liver transplantation (OLT) in children has seen significant improvements in recent years. Long-term immunosuppressive strategies have focused on avoiding the risks of long-term immunosuppression, particularly nephrotoxicity, de novo malignancy and late infections. Since its introduction in renal transplantation in 1999, sirolimus (SRL) has been used by an increasing number of liver transplant centers. The aim of this study was to review the experience using SRL in pediatric liver transplant recipients at a single center.


METHODS
Between 1989 and 2006, 318 children underwent OLT including 13 who were converted to SRL therapy because of tacrolimus-related side effects. The indications were posttransplant lymphoproliferative disease (PTLD; n = 11), nephrotoxicity (n = 1), and de novo autoimmune hepatitis (n = 1). One patient with PTLD previously concurrently displayed chronic rejection. SRL dosages ranged between 0.4 and 5 mg/d. The median duration of follow-up was 18 months.


RESULTS
PTLD recurred in 1 patient. There were no episodes of acute rejection. One child developed hyperlipidemia that resolved with diet and medication.


CONCLUSIONS
Conversion from tacrolimus to SRL in selected pediatric liver transplant recipients is safe. Children with PTLD may benefit from immunosuppression with SRL after liver transplantation.
Instituto da Criança, Hospital das Clínicas, Pediatric Surgery and Liver Transplantation Division, Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, Brazil. nelson.gibelli@icr.usp.br
N E M
NE
Gibelli
U
U
Tannuri
M L
ML
Pinho-Apezzato
A C A
AC
Tannuri
J G
JG
Maksoud-Filho
W C
WC
Andrade
M C P
MC
Velhote
M M
MM
Santos
A A R
AA
Ayoub
M
M
Marques da Silva
D000293:Adolescent; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007223:Infant; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology*; D019520:Living Donors; D008232:Lymphoproliferative Disorders / Q000209:etiology; D008297:Male; D011183:Postoperative Complications / Q000276:immunology; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D016559:Tacrolimus / Q000009:adverse effects; D014019:Tissue Donors
D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus