Premium
Growing experience with m TOR inhibitors in pediatric solid organ transplantation
Author(s) -
Ganschow R.,
Pape L.,
Sturm E.,
Bauer J.,
Melter M.,
Gerner P.,
Höcker B.,
Ahlenstiel T.,
Kemper M.,
Brinkert F.,
Sachse M. M.,
Tönshoff B.
Publication year - 2013
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12147
Subject(s) - medicine , transplantation , kidney transplantation , everolimus , liver transplantation , kidney , prospective cohort study , organ transplantation , clinical trial , urology , surgery
Controlled trials of m TOR inhibitors in children following solid organ transplantation are scarce, although evidence from prospective single‐arm studies is growing. Everolimus with reduced CNI therapy has been shown to be efficacious and safe in de novo pediatric kidney transplant patients in prospective trials. Prospective and retrospective data in children converted from CNI therapy to m TOR inhibition following kidney, liver, or heart transplantation suggest preservation of immunosuppressive efficacy. Good renal function has been maintained when m TOR inhibitors are used de novo in children following kidney transplantation or after conversion to m TOR inhibition with CNI minimization. m TOR inhibition with reduced CNI exposure is associated with a low risk for developing infection in children. Growth and development do not appear to be impaired during low‐dose m TOR inhibition, but more studies are required. No firm conclusions can be drawn as to whether m TOR inhibitors should be discontinued in children requiring surgical intervention or whether m TOR inhibition delays progression of hepatic fibrosis after pediatric liver transplantation. In conclusion, current evidence suggests that use of m TOR inhibitors in children undergoing solid organ transplantation is efficacious and safe, but a number of issues remain unresolved and further studies are required.