Dehghani S M, Shahramian I, Ataollahi M, Baz A, Foruzan H, Gholami S, Goli M
Shiraz Organ Transplantation Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran.
Int J Organ Transplant Med. 2020;11(4):177-184.
Long-term efficiency of attenuated immunosuppressive therapies is not well characterized in pediatric liver transplantation (LT).
To assess the efficiency of tacrolimus once daily (TAC-OD) and sirolimus once daily (SLR-OD) immunosuppression in pediatric LT.
We retrospectively evaluated 59 children who underwent LT in our center during 2002 to 2016. Those including children who underwent planned decrease in immunosuppressant dose (stable clinical conditions after 2 years of LT), and those who underwent unplanned decrease in immunosuppressant dose (because of complications such as post-transplant lymphoproliferative disorder [PTLD] and renal failure).
25 of 59 children underwent planned decrease in immunosuppressant dosage (mean±SD duration of 4.5±1.8, range: 3-11 years); 34 had unplanned decrease (mean±SD of 1.3±0.6, range: 0.5-2.6 years). 19 of 25 children with planned conversion received TAC-OD; 6 received SLR-OD (22 with 1 mg/day dose, and 3 with 1 mg every two days). Of 34 children with unplanned conversion, 27 received TAC-OD, 7 SLR-OD (25 children with 1 mg/day, 7 with 1 mg every two days, 1 with 0.5 mg/day TAC, and 1 with 0.5 mg TAC every two days). We found no adverse events including acute or chronic graft rejection, renal insufficiency, infections, PTLDs, or cardiovascular thrombotic events after initiation of the modified immunosuppression in none of the groups.
TAC-OD or SLR-OD monotherapies are safe and effective for long-term management of LT children with either stable clinical conditions or those with LT complications.
减毒免疫抑制疗法在小儿肝移植（LT）中的长期疗效尚未得到充分表征。
评估他克莫司每日一次（TAC-OD）和西罗莫司每日一次（SLR-OD）免疫抑制在小儿肝移植中的疗效。
我们回顾性评估了2002年至2016年期间在本中心接受肝移植的59名儿童。这些儿童包括那些计划减少免疫抑制剂剂量的儿童（肝移植2年后临床状况稳定），以及那些非计划减少免疫抑制剂剂量的儿童（由于移植后淋巴细胞增生性疾病[PTLD]和肾衰竭等并发症）。
59名儿童中有25名计划减少免疫抑制剂剂量（平均±标准差持续时间为4.5±1.8年，范围：3 - 11年）；34名非计划减少（平均±标准差为1.3±0.6年，范围：0.5 - 2.6年）。25名计划转换的儿童中有19名接受TAC-OD；6名接受SLR-OD（22名每日剂量为1mg，3名每两天剂量为1mg）。34名非计划转换的儿童中，27名接受TAC-OD，7名接受SLR-OD（25名每日剂量为1mg，7名每两天剂量为1mg，1名每日剂量为0.5mg TAC，1名每两天剂量为0.5mg TAC）。在任何一组中，我们在开始改良免疫抑制后均未发现不良事件，包括急性或慢性移植排斥反应、肾功能不全、感染、PTLD或心血管血栓形成事件。
TAC-OD或SLR-OD单药疗法对于临床状况稳定或有肝移植并发症的小儿肝移植患者的长期管理是安全有效的。
