AIM: To review our experience using sirolimus in a single center pediatric intestinal transplantation cohort. PATIENT/ METHODS: Intestinal transplant patients with more than 3 months follow-up were divided in two groups according to their immunosuppression regimen: tacrolimus, (TAC group, n=45 grafts) or sirolimus (SRL group, n=38 grafts), which included those partially or completely converted from tacrolimus to sirolimus. The indications to switch were tacrolimus side-effects and immunological complications. Survival and complications were retrospectively analyzed comparing both groups. RESULTS: SRL was introduced 9 months (0 months-16.9 years) after transplant. The main cause for conversion was worsening renal function (45%), followed by hemolytic anemia (21%) and graft-versus-host-disease (16%). Both groups showed a similar overall patient/graft survival (p=0.76/0.08) and occurrence of rejection (24%/17%, p=0.36). Immunological complications did not recur after conversion. Renal function significantly improved in most SRL patients. After a median follow-up of 65.17 months, 28/46 survivors were on SRL, 26 with monotherapy, with good graft function. CONCLUSIONS: Over one-third of our patients eventually required SRL conversion that allowed to improve their kidney function and immunological events, without entailing additional complications or survival impairment. Further trials are warranted to clarify the potential improvement of the standard tacrolimus maintenance by sirolimus conversion or addition. This article is protected by copyright. All rights reserved.
AIM: To review our experience using sirolimus in a single center pediatric intestinal transplantation cohort. PATIENT/ METHODS: Intestinal transplant patients with more than 3 months follow-up were divided in two groups according to their immunosuppression regimen: tacrolimus, (TAC group, n=45 grafts) or sirolimus (SRL group, n=38 grafts), which included those partially or completely converted from tacrolimus to sirolimus. The indications to switch were tacrolimus side-effects and immunological complications. Survival and complications were retrospectively analyzed comparing both groups. RESULTS:SRL was introduced 9 months (0 months-16.9 years) after transplant. The main cause for conversion was worsening renal function (45%), followed by hemolytic anemia (21%) and graft-versus-host-disease (16%). Both groups showed a similar overall patient/graft survival (p=0.76/0.08) and occurrence of rejection (24%/17%, p=0.36). Immunological complications did not recur after conversion. Renal function significantly improved in most SRLpatients. After a median follow-up of 65.17 months, 28/46 survivors were on SRL, 26 with monotherapy, with good graft function. CONCLUSIONS: Over one-third of our patients eventually required SRL conversion that allowed to improve their kidney function and immunological events, without entailing additional complications or survival impairment. Further trials are warranted to clarify the potential improvement of the standard tacrolimus maintenance by sirolimus conversion or addition. This article is protected by copyright. All rights reserved.