Introduction:The objective was to review our experience with Sirolimus (SRL) in intestinal transplant patients (IT).
Patients and Methods: Between 1999-2017, 100 IT were performed in 78 patients (mean age at transplant 37 months; range 6m-19y). 16 were retrasplant, 6 of them twice. The initial standard maintenance treatment was Tacrolimus (TAC). We retrospectively reviewed those patients who were partially or fully converted to SRL.
Results:From 2008, SRL was administered to 30 patients, after a median of 13 months since the transplant (1m-8y). The indication was Tacrolimus toxicity in 16 (worsening of renal function +/-hypertension in 12 and hypertrophic cardiomyopathy in 4) and/or immunological complications in 16 (chronic rejection in 1, hemolytic anemia in 6, graft versus host disease (GVHD) in 3, lymphoproliferative sindrome in 3, neutropenia in 1 and salvage therapy in 2). In addition, 11 patients had records of rejection and 9 more of GVHD. Six had been retrasplant.
Renal function improved in all patients during the follow-up (cystatin levels decreased from 3.30±0.69 mg/dl to 1.18±0.34). We did not find more immunological complications after the conversion to SRL. 6 patients died, 2 due to the evolution of chronic rejection and 4 because of GVHD, having debuted these complications before the conversion. The remaining 24 have good graft function. At the time of the study, 44 out of 78 patients were alive, 13 exclusively treated with SRL and 6 with SRL and TAC.
Conclusion:Although TAC remains the treatment of choice in IT maintenance, half of our living patients needed to convert to the SRL along the follow-up. It seems like a safe and effective treatment. Accumulated experience is encouraging us to expand its use in younger children, complex patients and initiating it sooner after transplant.