Andres Ane M, Talayero Paloma, Alcolea Sanchez Alida, Sanchez Galán Alba, Serradilla Rodríguez Javier, Bueno Jimenez Alba, Gonzalez Sacristan Rocío, Stringa Pablo, Papa Gobbi Rodrigo, Lasa Lazaro Maria, Díaz Almirón Mariana, Ramos Boluda Esther, Lopez Santamaría Manuel, Hernández Oliveros Francisco
Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain.
Idipaz Institute, La Paz University Hospital, Madrid, Spain.
Transpl Int. 2021 Oct;34(10):1895-1907. doi: 10.1111/tri.13959. Epub 2021 Sep 5.
To review our experience using sirolimus in a single centre paediatric intestinal transplantation cohort. Intestinal transplant patients with more than 3 months follow-up were divided into two groups according to their immunosuppression regimen: tacrolimus, (TAC group, n = 45 grafts) or sirolimus (SRL group, n = 38 grafts), which included those partially or completely converted from tacrolimus to sirolimus. The indications to switch were tacrolimus side effects and immunological complications. Survival and complications were retrospectively analysed comparing both groups. SRL was introduced 9 months (0 months-16.9 years) after transplant. The main cause for conversion was worsening renal function (45%), followed by haemolytic anaemia (21%) and graft-versus-host-disease (16%). Both groups showed a similar overall patient/graft survival (P = 0.76/0.08) and occurrence of rejection (24%/17%, P = 0.36). Immunological complications did not recur after conversion. Renal function significantly improved in most SRL patients. After a median follow-up of 65.17 months, 28/46 survivors were on SRL, 26 with monotherapy, with good graft function. Over one-third of our patients eventually required SRL conversion that allowed to improve their kidney function and immunological events, without entailing additional complications or survival impairment. Further trials are warranted to clarify the potential improvement of the standard tacrolimus maintenance by sirolimus conversion or addition.
回顾我们在单中心儿科肠道移植队列中使用西罗莫司的经验。对随访超过3个月的肠道移植患者，根据其免疫抑制方案分为两组：他克莫司组（TAC组，45例移植）或西罗莫司组（SRL组，38例移植），后者包括部分或完全从他克莫司转换为西罗莫司的患者。转换的指征为他克莫司副作用和免疫并发症。对两组的生存情况和并发症进行回顾性分析比较。移植后9个月（0个月至16.9年）开始使用SRL。转换的主要原因是肾功能恶化（45%），其次是溶血性贫血（21%）和移植物抗宿主病（16%）。两组患者/移植物总体生存率相似（P = 0.76/0.08），排斥反应发生率也相似（24%/17%，P = 0.36）。转换后免疫并发症未复发。大多数SRL患者的肾功能显著改善。中位随访65.17个月后，46例幸存者中有28例使用SRL，26例为单药治疗，移植物功能良好。我们超过三分之一的患者最终需要转换为SRL，这使得他们的肾功能和免疫相关事件得到改善，且未引发额外并发症或影响生存。有必要进行进一步试验，以阐明通过西罗莫司转换或添加来改善标准他克莫司维持治疗的潜在效果。
