Clinical Fellow in Paediatric Hepatology
Children's Liver Unit
Leeds General Infirmary
A single center experience in using sirolimus in pediatric liver transplant
Rayna Alamurova1, Sanjay Rajwal1, Suzanne Davison1, Penny North-Lewis1, Patricia McClean1.
1Children's Liver Unit, Leeds Children's Hospital, Leeds, United Kingdom
Introduction: Sirolimus (rapamycin) is a macrolide immunosuppressive agent. It supresses the T-cell response to IL-2 by binding to and inhibiting the mechanistic target of rapamycin (mTOR). Sirolimus (SRL) has been used in children after solid organ transplantation. There are only a small number of studies on mTOR inhibitor-based maintenance immunosuppression in paediatric liver transplant recipients.
Methods: Retrospective review of medical records of paediatric liver transplant recipients, who were commenced on SRL between 2011 and 2018. Indications, safety and efficacy were assessed.
Results: 13 patients received SRL: 1 bile salt export pump (BSEP) disease recurrence (to increase immunosuppression), 2 chronic rejection [ both needed retransplant, 1 then developed posttransplant lymphoproliferative disease (PTLD) so SRL recommenced ], 1 hepatocellular carcinoma (HCC), 2 low glomerular filtration rate (GFR), 7 PTLD, 1 unknown (started in other centre). 9 patients remain on SRL, with mean follow up 31 months ( 8 months - 7 years ), 6 of them with PTLD. SRL was discontinued in : 1 patient with BSEP recurrence, who developed Pneumocystis Carinii Pneumonia (PCP) at 3 months; 1 patient with pulmonary toxicity; 1 patient who required retransplant for chronic rejection and 1 patient had tumour recurrence who died. In PTLD group there was no disease recurrence. 1 patient had acute cellular rejection 2 months post starting SRL. Two patients had septic episodes 1 month post starting SRL, caused by Citrobacter in one and E.coli, Raoutella mixed infection in the other. 1 patient had lymphadenitis within a month and recurrent ear infections later. 2 patients had mild hyperlipidaemia. Renal function stabilized in the 2 children with low GFR, however follow up was short, 1y9m and 2y8m, respectively. Mild hypertension and hyperlipidaemia also resolved on discontinuing SRL. There were no wound healing or vascular complications. Myelosuppression, rashes and mouth ulcers were not seen in patients on SRL.
Conclusion: Our data suggest that SRL has a role in selected paediatric liver transplant recipients but careful monitoring is required.
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18:30 - 20:00
|Poster Session 1||Initial experience with biodegradable stents for treatment of anastomotic biliary strictures in a single paediatric liver transplant center||Exhibit-Poster Area|
18:30 - 20:00
|Poster Session 1||A single center experience in using sirolimus in pediatric liver transplant||Exhibit-Poster Area|