title: Sirolimus as renal and immunological rescue agent in pediatric liver transplant recipients.
abstract: CNI have improved the outcome of LT. However, their inherent potential to nephrotoxic and sometimes-inadequate immunosuppressive effect has lead to the usage of newer drugs like SRL. Aim of this study was to review children who received SRL. Thirty-seven (20 women) children post-LT, median age 10.4 yr (0.8-17.4) with a minimum follow-up of six months comprised the study group. Indications for SRL were biopsy-proven resistant acute allograft rejection (n = 12), early CR (n = 12), and CNI-induced nephropathy with MMF intolerance (n = 11). In two patients, the indication was the recurrence of BSEP disease in the allograft. In patients with acute rejection, AST normalized in 10/12 patients. In patients with CR, AST normalized in 6/12 patients. Those with renal impairment showed improvement in their creatinine levels from a mean baseline of 99-56.7 μm (p = 0.03) and their mean cystatin C was 1.02 after SRL. Side effects leading to discontinuation of SRL were seen in three patients. SRL was effective in rescuing patients with acute and chronic allograft rejection and improving renal function in CNI-induced nephropathy group.
authors: Paediatric Liver, GI and Nutrition Centre, Institute of Liver Studies, King's College Hospital, London, UK.
authors: Maria-Sole
authors: MS
authors: Basso
authors: Pushpa
authors: P
authors: Subramaniam
authors: Mike
authors: M
authors: Tredger
authors: Anita
authors: A
authors: Verma
authors: Nigel
authors: N
authors: Heaton
authors: Mohamed
authors: M
authors: Rela
authors: Giorgina
authors: G
authors: Mieli-Vergani
authors: Anil
authors: A
authors: Dhawan
mesh_terms: D000293:Adolescent; D065095:Calcineurin Inhibitors; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D007107:Immune System; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D010372:Pediatrics / Q000379:methods; D051437:Renal Insufficiency / Q000208:ethnology / Q000628:therapy; D020123:Sirolimus / Q000494:pharmacology*; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D020123:Sirolimus