Sirolimus to treat chronic and steroid-resistant allograft rejection-related fibrosis in pediatric liver transplantation.

Autor: Quintero Bernabeu J; Pediatric Hepatology and Liver Transplant Department, ERN Rare Liver - ERN TrasplantChild, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Juamperez Goñi J; Pediatric Hepatology and Liver Transplant Department, ERN Rare Liver - ERN TrasplantChild, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Mercadal Hally M; Pediatric Hepatology and Liver Transplant Department, ERN Rare Liver - ERN TrasplantChild, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Padrós Fornieles C; Pediatric Hepatology and Liver Transplant Department, ERN Rare Liver - ERN TrasplantChild, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Ortega López J; Pediatric Intensive Care Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Larrarte King M; Pediatric Hepatology and Liver Transplant Department, ERN Rare Liver - ERN TrasplantChild, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Molino Gahete JA; Pediatric Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Salcedo Allende MT; Histology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Hidalgo Llompart E; HPB Surgery and Transplants, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Bilbao Aguirre I; HPB Surgery and Transplants, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Charco Torra R; HPB Surgery and Transplants, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Jazyk: angličtina
Zdroj: Journal of pediatric gastroenterology and nutrition [J Pediatr Gastroenterol Nutr] 2024 Nov; Vol. 79 (5), pp. 962-968. Date of Electronic Publication: 2024 Jul 08.
DOI: 10.1002/jpn3.12286
Abstrakt: This study aimed to report our experience with the use of Sirolimus (SRL) in pediatric liver transplant patients with chronic rejection or steroid-resistant rejection with hepatic fibrosis, focusing on their histological evolution. All pediatric liver transplant recipients who received off-label treatment with SRL for chronic ductopenic rejection or cortico-resistant rejection between July 2003 and July 2022 were included in the study. All nine patients included in the study showed improvement in liver enzymes and cholestasis parameters as soon as 1-month after post-SRL introduction. A decrease in fibrosis stage was observed in 7/9 (77.7%) patients at 36 months. All but one patient experienced an improvement in the Rejection Activity Index and ductopenia at 12 months. A single patient had to discontinue SRL treatment owing to nephrotic proteinuria. In conclusion, SRL may be a safe and effective treatment for chronic and steroid-resistant rejection and may improve allograft rejection-related fibrosis and ductal damage.
(© 2024 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)
Databáze: MEDLINE
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