Sirolimus en trasplante de órgano sólido pediátrico: Experiencia en 5 casos

Abstract

Use of Sirolimus in five pediatric patients undergoing solid organ transplantation Background: Sirolimus (SRL) is an immunosuppressive drug increasingly used in children undergoing solid organ transplantation. SRL does not cause glucose intolerance, hypertension, nephrotoxicity or neurotoxicity, offering significant potential advantages over calceneurin inhibitors (CNI). Aim: To report five children treated with SRL. Material and methods: A retrospective review of four children undergoing orthotopic liver transplantation (OLT) and one undergoing renal transplantation with recurrent acute rejection (RAR), chronic rejection (CR) or toxicity due to CNI, treated with SRL between June 2001 and November 2006. Results: As primary immunosuppressive therapy, all patients received 3 drugs: CNI (Tacrolimus (FK) or Cyclosporine), mycophenolate mofetil and steroids. Mean age at treatment with SRL was 98 months. Children undergoing OLT had a late introduction of SRL (mean time after OLT: 37 months), and mean follow-up was 24 months. In this group rescue indications of SRL were RAR in one, CR in one, thrombotic thrombocytopenic purpura (TTP) in one, food allergy in one and other CNI toxicity in three. Only one did not experience adverse events due to SRL, but no one required discontinuation of SRL. There were remissions of RAR, CR, TTP and food allergy. The patient with RT was switched from FK to SRL at day 18 th after RT, but he had severe neutropenia that led to discontinuation of SRL. Conclusions: SRL may be useful in pediatric solid organ transplant recipients suffering from RAR, CR, TTP, food allergy and CNI toxicity. Careful attention should be directed to detect side effects and avoid severe complications (

Severe adverse events during sirolimus “off label” therapy for vascular anomalies

“…The possibility to measure sirolimus serum trough levels makes the therapy well controllable. There is, however, no recommendation for an effective and safe serum level for pediatric patients [16]. Furthermore, data on safety of sirolimus therapy in children for its use in the approved indications is scarce.…”

Sirolimus (rapamicina) en pacientes con hemangioendotelioma kaposiforme: Caso clínico

“…Recientemente, se han publicado casos de pacientes con HEK refractarios y riesgo vital, en quienes se obtuvo respuesta significativa con Sirolimus (SRL) 4,7 . Nuestro objetivo fue reportar la experiencia en dos casos clínicos con HEK asociado a FKM, con complicaciones severas, refractarios a los tratamientos habituales y en los que se decidió utilizar SRL, siendo los primeros pacientes con HEK en Chile que reciben este tratamiento, ya que en pediatría su uso estaba limitado principalmente a pacientes con trasplante de órganos sólidos (hígado, riñón) 11,12 .…”