title: Long-term side effects of treatment with mTOR inhibitors in children after renal transplantation.
abstract: BACKGROUND
  mTOR inhibitors (mTORI) have emerged as alternative and additive immunosuppressive agents in pediatric renal transplantation (pRTx). Their immunosuppressive, anti-proliferative, and anti-neoplastic mechanisms have been described to be effective, whereas some side effects are alarming. In particular, growth and pubertal development are of concern. The aim of this study was to look for long-term side effects of mTORI therapy in pRTx.
  
  
  METHODS
  The retrospective analysis focused on side effects, growth, and pubertal development under mTORI therapy in 31 children. Eighteen children were routinely monitored for estradiol, testosterone, LH, and FSH levels.
  
  
  RESULTS
  The occurrence of bacterial infections, lymphoceles, myelosuppression, and the course of overall linear growth was comparable with other pediatric renal transplant cohorts. According to the clinical puberty status, all but one patient showed normal age-related development in parallel to normal serum hormone levels. Only one patient experienced cytomegaly virus infection under mTORI, no post-transplant lymphoproliferative disorders (PTLD) occurred.
  
  
  CONCLUSIONS
  Long-term mTORI therapy is safe in pRTx. No negative impact on growth and pubertal development was observed.
authors.affiliation: Department of General Pediatrics, Pediatric Nephrology, University Children's Hospital Münster, Waldeyerstrasse 22, 48149, Münster, Germany. kranzab@uni-muenster.de
authors.forename: Birgitta
authors.initials: B
authors.lastname: Kranz
authors.forename: Anne-Margret
authors.initials: AM
authors.lastname: Wingen
authors.forename: Udo
authors.initials: U
authors.lastname: Vester
authors.forename: Jens
authors.initials: J
authors.lastname: König
authors.forename: Peter F
authors.initials: PF
authors.lastname: Hoyer
mesh_terms: D000293:Adolescent; D001827:Body Height / Q000187:drug effects; D002648:Child; D002657:Child Development / Q000187:drug effects; D002675:Child, Preschool; D004958:Estradiol / Q000097:blood; D005260:Female; D043373:Follicle Stimulating Hormone, Human / Q000097:blood; D005858:Germany; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007223:Infant; D016030:Kidney Transplantation / Q000009:adverse effects*; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D011627:Puberty / Q000097:blood / Q000187:drug effects; D012189:Retrospective Studies; D012307:Risk Factors; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors* / Q000378:metabolism; D013739:Testosterone / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D043373:Follicle Stimulating Hormone, Human; D007166:Immunosuppressive Agents; D047428:Protein Kinase Inhibitors; D013739:Testosterone; D004958:Estradiol; D007986:Luteinizing Hormone; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases