title: Extended follow-up of pediatric liver transplantation patients receiving once daily calcineurin inhibitor.
abstract: We describe longitudinal results in a cohort of pediatric liver transplant patients successfully minimized to once daily CNI monotherapy for longer than five yr and assess changes in liver biochemistries and liver histology. A retrospective chart review of all pediatric liver transplant patients at a single center was performed. Biopsies and serum biochemistries (AST, ALT, total bilirubin, direct bilirubin, INR, creatinine) are reported at time points: PM, five-yr, seven-yr, and nine-yr post-minimization. Biopsies were assessed for inflammation and fibrosis using Ishak and Batts grading systems. Successful minimization to daily CNI monotherapy was defined as normal liver enzymes with no episodes of rejection. Thirty-three patients have successfully remained on once daily CNI for >5 yr, and 19/33 of these patients have serial liver biopsies available for review. We report on the clinical and histological findings of these 19 patients. All 19 patients continue to have normal liver biochemistries. On post-minimization biopsies, fibrosis progressed by ≥2 stages in one patient (5.3%) despite normal liver biochemistries. Carefully selected patients can tolerate minimization to once daily CNI monotherapy as few have progression of fibrosis.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Hector
authors.initials: H
authors.lastname: Melin-Aldana
authors.affiliation: Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Saeed
authors.initials: S
authors.lastname: Mohammad
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Udeme D
authors.initials: UD
authors.lastname: Ekong
authors.affiliation: Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Estella M
authors.initials: EM
authors.lastname: Alonso
mesh_terms: D065095:Calcineurin Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents
keywords: calcineurin inhibitors; immunosuppression minimization; liver transplant; pediatric transplantation