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Delayed introduction of sirolimus in paediatric intestinal transplant recipients: indications and long‐term benefits

2021; Springer Science+Business Media; Volume: 34; Issue: 10 Linguagem: Inglês

10.1111/tri.13959

1432-2277

Ane Miren Andrés, Paloma Talayero, Alida Alcolea Sánchez, Alba Galán, Javier Serradilla, A. Jiménez, Rocío González Sacristán, Pablo Stringa, Rodrigo Papa Gobbi, Maria Lasa Lazaro, Mariana Díaz Almirón, Esther Ramos Boluda, Manuel Santamarı́a, F Hernández,

Organ Transplantation Techniques and Outcomes

To review our experience using sirolimus in a single centre paediatric intestinal transplantation cohort. Intestinal transplant patients with more than 3 months follow-up were divided into 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 analysed comparing both groups. SRL was introduced 9 months (0 months-16.9 years) after transplant. The main cause for conversion was worsening renal function (45%), followed by haemolytic anaemia (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. 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.