Open AccessRole of Budesonide for the Treatment of Rejection in Pediatric Liver Transplantation
Author(s) -
Chen Justin,
Ferreira Johanna,
Martinez Mercedes,
Lobritto Steven,
Goldner Dana,
Vittorio Jennifer
Publication year - 2020
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000002784
Subject(s) - budesonide , medicine , adverse effect , corticosteroid , liver transplantation , immunosuppression , gastroenterology , transplantation
Corticosteroids are an integral part of liver transplant (LT) immunosuppression regimens but are often accompanied by many adverse effects. Budesonide is an oral corticosteroid with extensive (80%–90%) hepatic first‐pass metabolism and minimal systemic absorption. The aim of this study was to examine the safety and efficacy of budesonide for management of acute cellular rejection (ACR) in pediatric LT recipients. Methods: A retrospective descriptive analysis was performed for all pediatric patients who underwent LT at our center and were prescribed oral budesonide for the treatment of ACR. Alanine aminotransferase (ALT) values and documented adverse effects were reviewed. Results: Twenty‐nine patients were prescribed budesonide for the treatment of ACR; 65.5% with biopsy‐proven acute rejection and 34.5% with presumed ACR. There was a significant decrease in ALT noted from the time of rejection when compared to values 1 month ( P = 0.0011), 3 months ( P = 0.0003), and 6 months ( P = 0.0001) after treatment with budesonide. There was no difference noted between patient baseline ALT levels before rejection when compared to 1, 3, and 6 months posttreatment values suggesting resolution of rejection. Three patients required conversion from budesonide to systemic steroids. There were no discontinuations of budesonide secondary to adverse effects. Conclusion: Oral budesonide may be a promising alternative to systemic corticosteroids for the management of mild/moderate ACR and for empiric treatment of ACR in select pediatric LT recipients. Data from this study may provide the foundation for larger, prospective, multicenter trials to assess the effectiveness of budesonide in the treatment of ACR.