Gibelli N E M, Tannuri U, Pinho-Apezzato M L, Tannuri A C A, Maksoud-Filho J G, Andrade W C, Velhote M C P, Santos M M, Ayoub A A R, Marques da Silva M
Instituto da Criança, Hospital das Clínicas, Pediatric Surgery and Liver Transplantation Division, Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, Brazil.
Transplant Proc. 2009 Apr;41(3):901-3. doi: 10.1016/j.transproceed.2009.01.054.
Liver transplantation (OLT) in children has seen significant improvements in recent years. Long-term immunosuppressive strategies have focused on avoiding the risks of long-term immunosuppression, particularly nephrotoxicity, de novo malignancy and late infections. Since its introduction in renal transplantation in 1999, sirolimus (SRL) has been used by an increasing number of liver transplant centers. The aim of this study was to review the experience using SRL in pediatric liver transplant recipients at a single center.
Between 1989 and 2006, 318 children underwent OLT including 13 who were converted to SRL therapy because of tacrolimus-related side effects. The indications were posttransplant lymphoproliferative disease (PTLD; n = 11), nephrotoxicity (n = 1), and de novo autoimmune hepatitis (n = 1). One patient with PTLD previously concurrently displayed chronic rejection. SRL dosages ranged between 0.4 and 5 mg/d. The median duration of follow-up was 18 months.
PTLD recurred in 1 patient. There were no episodes of acute rejection. One child developed hyperlipidemia that resolved with diet and medication.
Conversion from tacrolimus to SRL in selected pediatric liver transplant recipients is safe. Children with PTLD may benefit from immunosuppression with SRL after liver transplantation.
近年来，儿童肝移植（OLT）取得了显著进展。长期免疫抑制策略一直聚焦于避免长期免疫抑制带来的风险，尤其是肾毒性、新发恶性肿瘤和晚期感染。自1999年西罗莫司（SRL）被引入肾移植以来，越来越多的肝移植中心开始使用它。本研究的目的是回顾单中心在小儿肝移植受者中使用SRL的经验。
1989年至2006年间，318名儿童接受了OLT，其中13名因他克莫司相关副作用转而接受SRL治疗。适应证为移植后淋巴细胞增生性疾病（PTLD；n = 11）、肾毒性（n = 1）和新发自身免疫性肝炎（n = 1）。1例PTLD患者此前同时出现慢性排斥反应。SRL剂量为0.4至5mg/d。中位随访时间为18个月。
1例患者PTLD复发。无急性排斥反应发作。1名儿童出现高脂血症，通过饮食和药物治疗得以缓解。
在选定的小儿肝移植受者中，从他克莫司转换为SRL是安全的。PTLD患儿肝移植后使用SRL免疫抑制可能有益。
