Delayed introduction of sirolimus in paediatric intestinal transplant recipients: indications and long-term benefits

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.Fil: Andres, Ane M.. Hospital Universitario la Paz; EspañaFil: Talayero, Paloma. Hospital Universitario 12 de Octubre; EspañaFil: Alcolea Sanchez, Alida. No especifíca;Fil: Sanchez Galán, Alba. Hospital Universitario la Paz; EspañaFil: Serradilla Rodríguez, Javier. Hospital Universitario la Paz; EspañaFil: Bueno Jimenez, Alba. Hospital Universitario la Paz; EspañaFil: Gonzalez Sacristan, Rocío. No especifíca;Fil: Stringa, Pablo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Estudios Inmunológicos y Fisiopatológicos. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Estudios Inmunológicos y Fisiopatológicos; ArgentinaFil: Papa Gobbi, Rodrigo. Hospital Universitario la Paz; EspañaFil: Lasa Lazaro, Maria. Hospital Universitario 12 de Octubre; EspañaFil: Díaz Almirón, Mariana. Hospital Universitario la Paz; EspañaFil: Ramos Boluda, Esther. No especifíca;Fil: Lopez Santamaría, Manuel. Hospital Universitario la Paz; EspañaFil: Hernández Oliveros, Francisco. Hospital Universitario la Paz; Españ