Conversion from tacrolimus to sirolimus as a treatment modality in de novo allergies and immune-mediated disorders in pediatric liver transplant recipients.
Calcineurin Inhibitors
/ pharmacology
Child
Child, Preschool
End Stage Liver Disease
/ surgery
Female
Follow-Up Studies
Graft Rejection
Humans
Immune System
Immunosuppression Therapy
Immunosuppressive Agents
/ therapeutic use
Infant
Liver Transplantation
/ methods
Male
Retrospective Studies
Sirolimus
/ administration & dosage
TOR Serine-Threonine Kinases
/ antagonists & inhibitors
Tacrolimus
/ administration & dosage
Treatment Outcome
eczema
eosinophilic colitis
eosinophilic gastroenteritis
food allergy
immune dysregulation
tacrolimus
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
19
08
2019
revised:
31
01
2020
accepted:
20
04
2020
pubmed:
20
5
2020
medline:
31
8
2021
entrez:
20
5
2020
Statut:
ppublish
Résumé
De novo PTAID may develop in pediatric solid organ transplant recipients, have a diverse spectrum, and are occasionally treatment resistant. Previous reports showed resolution of immune cytopenias in solid organ transplant recipients following replacement of the calcineurin inhibitor tacrolimus with the mTOR inhibitor sirolimus. Herein we describe a retrospective review (2000-2017) of subjects who developed PTAID in whom immunosuppression was changed to sirolimus. Eight recipients (6 males) of either liver (n = 7) or multivisceral transplant (n = 1) suffered from severe, treatment-resistant PTAID and were switched from tacrolimus to sirolimus. The median age at transplant was 1 year (range 0.5-2.4 years). Six (75%) recipients developed de novo allergy and 2 immune-mediated diseases. The median age at presentation of PTAID was 2.7 (1.4-9) years at a median of 1.3 (0.25-8) years after transplantation. The median time from PTAID presentation to conversion to sirolimus was 1.8 (0.45-10) years. Complete resolution of symptoms was seen in 4 (50%) patients after a median of 12 (range 4-24) months including 2 patients with immune-mediated disease, 1 eczema, and 1 with eosinophilic colitis. One patient with multiple food allergies had a partial response and 3 (38%) had no response. None of the 8 recipients developed sirolimus-attributed adverse events or acute rejection during a median follow-up of 5 (0.6-8) years after the conversion. Immunosuppression conversion from tacrolimus to sirolimus can be an effective therapy in patients suffering severe or treatment-resistant PTAID, suggesting a potential role for tacrolimus in the pathogenesis of PTAID.
Substances chimiques
Calcineurin Inhibitors
0
Immunosuppressive Agents
0
TOR Serine-Threonine Kinases
EC 2.7.11.1
Sirolimus
W36ZG6FT64
Tacrolimus
WM0HAQ4WNM
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13737Informations de copyright
© 2020 Wiley Periodicals LLC.
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