mTOR inhibitors in pediatric liver transplant recipients - 25/07/19
, Eduardo Couchonnal c, Florence Lacaille d, Christine Rivet c, Dominique Debray d, e, Olivier Boillot a, b, Alain Lachaux b, c, Oanez Ackermann f, Emmanuel Gonzales f, g, Barbara E. Wildhaber h, Emmanuel Jacquemin f, g, Valérie McLin hBienvenue sur EM-consulte, la référence des professionnels de santé.
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Highlights |
• | mTOR inhibitors (mTORi), everolimus and sirolimus, are increasingly used after adult liver transplantation (LT). Data on their use in pediatric LT recipients are scarce. |
• | Main indications for mTORi introduction were pre-existing liver malignancy, calcineurine inhibitor (CNI) nephrotoxicity, or rejection. |
• | The main adverse events included hyperlipidemia, proteinuria, dermatitis, and mucitis. Overall mTORi discontinuation rate was 23.3% (10.0% because of adverse event). |
• | mTORi can be used in pediatric LT recipients in different clinical situations, both to reinforce immunosuppressive therapy, and to reduce CNI and related toxicity. |
Summary |
Background |
During the past decade, mTOR inhibitors (mTORi), everolimus and sirolimus, have been increasingly used after adult liver transplantation (LT). The aim of the present study was to describe the use of mTORi in pediatric LT recipients.
Methods |
All pediatric LT recipients who received mTORi before December 2017 from 4 European pediatric LT centers were included and analyzed.
Results |
The present retrospective study included 30 patients; 21 were male (70%), median age was 9.3 years (range: 1.2–17.1 years) at mTORi introduction. Main indications for mTORi introduction were pre-existing liver malignancy (43.3%), calcineurin inhibitor (CNI) nephrotoxicity (26.7%), or rejection (23.4%). At last follow-up, mTORi CNIs were withdrawn in 10 patients (10/29, 34.5%). The median dose of mTORi was 1.8 mg/day (range: 0.3–5.0) or 0.058 mg/kg/day (range: 0.01–0.26), and the median trough level was 5.1 μg/L (range: 1.0–15.5). After a median follow-up of 2.8 years (range: 0.2–10.0), 50.0% of the patients presented with at least one adverse event. The main adverse events included hyperlipidemia, proteinuria, dermatitis, and mucitis. Overall mTORi discontinuation rate was 23.3% (10.0% because of adverse event). Introduction of mTORi had no significant impact on renal function.
Conclusion |
Our results suggest that mTORi can be used in pediatric LT recipients in different clinical situations, both to reinforce immunosuppressive therapy, and to reduce CNI and related toxicity.
Le texte complet de cet article est disponible en PDF.Keywords : liver transplantation, pediatric, mTOR inhibitor, outcome
Plan
Vol 43 - N° 4
P. 403-409 - août 2019 Retour au numéro
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