Rejection Episodes and 3-Year Graft Survival Under Sirolimus and Tacrolimus Treatment After Adult Intestinal Transplantation

Lauro, Augusto; Dazzi, A.; Ercolani, Giorgio; Zanfi, Chiara; Golfieri, Lucia; Amaduzzi, A.; Cucchetti, Alessandro; Barba, Giuliano La; Grazi, Gian Luca; D’Errico, Antonietta; Vivarelli, Marco; Cescon, Matteo; Varotti, Giovanni; Gaudio, Massimo Del; Ravaioli, Matteo; Simone, Massimo Pierluigi Di; Faenza, Stefano; Pironi, Loris; Pinna, Antonio

doi:10.1016/j.transproceed.2007.02.067

Cited by 25 publications

(17 citation statements)

References 9 publications

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“…However, the literature about SRL in pediatric SBTx recipients is limited. The combined use of SRL and CNI versus monotherapy demonstrated less rejection and higher survival rates (5). The Mount Sinai group demonstrated less reoperation rate, less early rejection, and better one‐yr graft and patient survival (11).…”

Section: Discussionmentioning

confidence: 99%

“…(14) reported 12% conversion back to TAC in a series of 85 pediatric liver recipients for acute rejection (12%), liver dysfunction, severe leukopenia, recurrent malignancy‐death, and thrombocytopenic purpura. Other groups reported 26% of conversion because of sepsis or myelotoxicity (5). However, all patients in our series except for the one who died remained on SRL since its introduction, without rejection or relevant side effects; thus, we consider that SRL is a safe immunosuppressant and may be used earlier prior to the onset of other complications.…”

Section: Discussionmentioning

confidence: 99%

“…Sirolimus (SRL, rapamycin) is an alternative that has been tried in combination or as substitute of TAC, with encouraging results in those patients with rejection or CNI toxicity (4–6); however, the historically described risk of thrombosis or impaired wound healing makes difficult to start prospective studies using SRL as primary immunosuppressant. Furthermore, the number of pediatric cases reported converted from TAC to SRL after intestinal transplantation is even more limited, the reason for conversion varies among groups, and the optimal dose to provide enough immunosuppression without causing serious adverse effects is still unclear (7).…”

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confidence: 99%

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The use of sirolimus as a rescue therapy in pediatric intestinal transplant recipients

Andrés¹,

Santamarı́a²,

Ramos

et al. 2010

Pediatric Transplantation

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To review our experience with SRL as a second-line therapy in our series of 45 SBTx recipients (1997-2009). Retrospective review of five children converted to SRL: 3 M/2 F; median of three yr old (range 20 months-18 yr); rescue indications, adverse events with SRL, resolution of tacrolimus-related side effects, incidence of rejection, PTLD, or GVHD were summarized. Tacrolimus was discontinued (average 13 months after transplant) because of refractory hemolytic anemia in four patients with decreased renal function and because of advanced renal failure and unclear neutropenia in one. PTLD and GVHD had been previously diagnosed in two. Tacrolimus-related side effects disappeared in all five although other immunosuppressants and splenectomy were used simultaneously or later in most of them. Adverse events reported after the conversion were infections (tuberculosis and Pneumocystis carinii in two) and mild hypertriglyceridemia. No rejection, GVHD, or PTLD episode was observed. Four patients are alive with excellent quality of life (median follow-up 18 months). Sirolimus is a safe rescue therapy in SBTx children when tacrolimus is not well tolerated. Renal function and hematologic disorders seem to improve, although other simultaneous strategies could be also involved. Further studies could demonstrate its efficacy as a first-line treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The use of sirolimus as a rescue therapy in pediatric intestinal transplant recipients

Andrés¹,

Santamarı́a²,

Ramos

et al. 2010

Pediatric Transplantation

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“…Total bilirubin (µmol/L) a 18 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) Portal fibrosis ≥ F3 b,d 2 (25) Abbreviations: ITx, intestinal transplantation; SD, standard deviation. a Median (interquartile range).…”

Section: Parameters Valuesmentioning

confidence: 99%

Beyond 10 years, with or without an intestinal graft: Present and future?

Courbage

Canioni

Talbotec

et al. 2020

American Journal of Transplantation

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Long-term outcomes in children undergoing intestinal transplantation remain unclear. Seventy-one children underwent intestinal transplantation in our center from 1989 to 2007. We report on 10-year posttransplant outcomes with (group 1, n = 26) and without (group 2, n = 9) a functional graft. Ten-year patient and graft survival rates were 53% and 36%, respectively. Most patients were studying or working, one third having psychiatric disorders. All patients in group 1 were weaned off parenteral nutrition with mostly normal physical growth and subnormal energy absorption. Graft histology from 15 late biopsies showed minimal abnormality. However, micronutrient deficiencies and fat malabsorption were frequent; biliary complications occurred in 4 patients among the 17 who underwent liver transplantation; median renal clearance was 87 mL/min/1.73 m 2. Four patients in group 1 experienced late acute rejection. Among the 9 patients in group 2, 4 died after 10 years and 2 developed significant liver fibrosis. Liver transplantation and the use of a 3-drug regimen including sirolimus or mycophenolate mofetil were associated with improved graft survival. Therefore, intestinal transplantation may enable a satisfactory digestive function in the long term. The prognosis of graft removal without retransplantation is better than expected. Regular monitoring of micronutrients, early psychological assessment, and use of sirolimus are recommended.

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“…Sirolimus, a rapamycin inhibitor, has been shown as a useful adjunct to tacrolimus in the presence of nephrotoxicity or rejection [40]. However, it carries the disadvantage of severe debilitating oromucosal ulceration.…”

Section: Immunosuppressionmentioning

confidence: 99%

Autologous Intestinal Reconstruction Surgery

2011

Clinical Management of Intestinal Failure

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Intestinal transplantation (ITx) has evolved in the past few decades moving from an experimental procedure to a life-changing modality for patients suffering from intestinal failure (IF). It is particularly for those with complications as a consequence of parenteral nutrition and/or who have a high risk of dying due to their underlying disease. In addition to this, intestinal transplantation is also increasingly considered for the treatment of conventionally unresectable abdominal tumors. With advancements in immunosuppressive drugs, induction regimens, standardization of surgical techniques and improved postoperative care, survival is increasing. The ultimate goal for intestinal transplantation would be to become as good and safe as total parenteral nutrition (TPN) and as such, it could become a viable first-line option of intestinal failure.

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Rejection Episodes and 3-Year Graft Survival Under Sirolimus and Tacrolimus Treatment After Adult Intestinal Transplantation

Cited by 25 publications

References 9 publications

The use of sirolimus as a rescue therapy in pediatric intestinal transplant recipients

The use of sirolimus as a rescue therapy in pediatric intestinal transplant recipients

Beyond 10 years, with or without an intestinal graft: Present and future?

Autologous Intestinal Reconstruction Surgery

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