Conversion from tacrolimus to sirolimus as a treatment modality in de novo allergies and immune‐mediated disorders in pediatric liver transplant recipients

De novo PTAID may develop in pediatric solid organ transplant recipients, have a diverse spectrum, and are occasionally treatment resistant. Previous reports showed resolution of immune cytopenias in solid organ transplant recipients following replacement of the calcineurin inhibitor tacrolimus with...

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Published inPediatric transplantation Vol. 24; no. 6; pp. e13737 - n/a
Main Authors Kehar, Mohit, Grunebaum, Eyal, Jimenez‐Rivera, Carolina, Mozer‐Glassberg, Yael, Jamal, Alisha, Ng, Vicky Lee, Avitzur, Yaron
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LanguageEnglish
Published Denmark Wiley Subscription Services, Inc 01.09.2020
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Abstract De novo PTAID may develop in pediatric solid organ transplant recipients, have a diverse spectrum, and are occasionally treatment resistant. Previous reports showed resolution of immune cytopenias in solid organ transplant recipients following replacement of the calcineurin inhibitor tacrolimus with the mTOR inhibitor sirolimus. Herein we describe a retrospective review (2000‐2017) of subjects who developed PTAID in whom immunosuppression was changed to sirolimus. Eight recipients (6 males) of either liver (n = 7) or multivisceral transplant (n = 1) suffered from severe, treatment‐resistant PTAID and were switched from tacrolimus to sirolimus. The median age at transplant was 1 year (range 0.5‐2.4 years). Six (75%) recipients developed de novo allergy and 2 immune‐mediated diseases. The median age at presentation of PTAID was 2.7 (1.4‐9) years at a median of 1.3 (0.25‐8) years after transplantation. The median time from PTAID presentation to conversion to sirolimus was 1.8 (0.45‐10) years. Complete resolution of symptoms was seen in 4 (50%) patients after a median of 12 (range 4‐24) months including 2 patients with immune‐mediated disease, 1 eczema, and 1 with eosinophilic colitis. One patient with multiple food allergies had a partial response and 3 (38%) had no response. None of the 8 recipients developed sirolimus‐attributed adverse events or acute rejection during a median follow‐up of 5 (0.6‐8) years after the conversion. Immunosuppression conversion from tacrolimus to sirolimus can be an effective therapy in patients suffering severe or treatment‐resistant PTAID, suggesting a potential role for tacrolimus in the pathogenesis of PTAID.
AbstractList De novo PTAID may develop in pediatric solid organ transplant recipients, have a diverse spectrum, and are occasionally treatment resistant. Previous reports showed resolution of immune cytopenias in solid organ transplant recipients following replacement of the calcineurin inhibitor tacrolimus with the mTOR inhibitor sirolimus. Herein we describe a retrospective review (2000‐2017) of subjects who developed PTAID in whom immunosuppression was changed to sirolimus. Eight recipients (6 males) of either liver (n = 7) or multivisceral transplant (n = 1) suffered from severe, treatment‐resistant PTAID and were switched from tacrolimus to sirolimus. The median age at transplant was 1 year (range 0.5‐2.4 years). Six (75%) recipients developed de novo allergy and 2 immune‐mediated diseases. The median age at presentation of PTAID was 2.7 (1.4‐9) years at a median of 1.3 (0.25‐8) years after transplantation. The median time from PTAID presentation to conversion to sirolimus was 1.8 (0.45‐10) years. Complete resolution of symptoms was seen in 4 (50%) patients after a median of 12 (range 4‐24) months including 2 patients with immune‐mediated disease, 1 eczema, and 1 with eosinophilic colitis. One patient with multiple food allergies had a partial response and 3 (38%) had no response. None of the 8 recipients developed sirolimus‐attributed adverse events or acute rejection during a median follow‐up of 5 (0.6‐8) years after the conversion. Immunosuppression conversion from tacrolimus to sirolimus can be an effective therapy in patients suffering severe or treatment‐resistant PTAID, suggesting a potential role for tacrolimus in the pathogenesis of PTAID.
De novo PTAID may develop in pediatric solid organ transplant recipients, have a diverse spectrum, and are occasionally treatment resistant. Previous reports showed resolution of immune cytopenias in solid organ transplant recipients following replacement of the calcineurin inhibitor tacrolimus with the mTOR inhibitor sirolimus. Herein we describe a retrospective review (2000‐2017) of subjects who developed PTAID in whom immunosuppression was changed to sirolimus. Eight recipients (6 males) of either liver (n = 7) or multivisceral transplant (n = 1) suffered from severe, treatment‐resistant PTAID and were switched from tacrolimus to sirolimus. The median age at transplant was 1 year (range 0.5‐2.4 years). Six (75%) recipients developed de novo allergy and 2 immune‐mediated diseases. The median age at presentation of PTAID was 2.7 (1.4‐9) years at a median of 1.3 (0.25‐8) years after transplantation. The median time from PTAID presentation to conversion to sirolimus was 1.8 (0.45‐10) years. Complete resolution of symptoms was seen in 4 (50%) patients after a median of 12 (range 4‐24) months including 2 patients with immune‐mediated disease, 1 eczema, and 1 with eosinophilic colitis. One patient with multiple food allergies had a partial response and 3 (38%) had no response. None of the 8 recipients developed sirolimus‐attributed adverse events or acute rejection during a median follow‐up of 5 (0.6‐8) years after the conversion. Immunosuppression conversion from tacrolimus to sirolimus can be an effective therapy in patients suffering severe or treatment‐resistant PTAID, suggesting a potential role for tacrolimus in the pathogenesis of PTAID.
Author Kehar, Mohit
Mozer‐Glassberg, Yael
Jamal, Alisha
Jimenez‐Rivera, Carolina
Grunebaum, Eyal
Ng, Vicky Lee
Avitzur, Yaron
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  organization: University of Toronto
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Issue 6
Keywords eczema
food allergy
tacrolimus
eosinophilic gastroenteritis
eosinophilic colitis
immune dysregulation
Language English
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Snippet De novo PTAID may develop in pediatric solid organ transplant recipients, have a diverse spectrum, and are occasionally treatment resistant. Previous reports...
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StartPage e13737
SubjectTerms Calcineurin
Calcineurin inhibitors
Colitis
Eczema
eosinophilic colitis
eosinophilic gastroenteritis
Food allergies
food allergy
Graft rejection
immune dysregulation
Immunosuppression
Leukocytes (eosinophilic)
Liver diseases
Liver transplantation
Liver transplants
Patients
Pediatrics
Rapamycin
Tacrolimus
TOR protein
Transplants & implants
Title Conversion from tacrolimus to sirolimus as a treatment modality in de novo allergies and immune‐mediated disorders in pediatric liver transplant recipients
URI https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fpetr.13737
https://www.ncbi.nlm.nih.gov/pubmed/32428390
https://www.proquest.com/docview/2436894134
https://search.proquest.com/docview/2405307531
Volume 24
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