OC8 Preservation of graft function with low rejection rates and good safety profile in paediatric liver transplant recipients on sirolimus

• Published in: Frontline gastroenterology 2024-07, Vol.15 (Suppl 1), p.A6-A7
• Main Authors: Lucas, Sandra Fernandes, North-Lewis, Penny, Mtegha, Marumbo, Jayaprakash, Kavitha, Karthikeyan, Palaniswamy, Rajwal, Sanjay, Warner, Suzan
• Format: Article
• Language: English
• Subjects: Abstracts; Gallbladder diseases; Liver transplants; Lymphatic diseases; Pediatrics
• ISSN: 2041-4137; 2041-4145
• DOI: 10.1136/flgastro-2024-bspghan.8

Tacrolimus, a calcineurin inhibitor, is the maintenance immunosuppression of choice in paediatric liver transplant (LT) recipients.1–3 However, in selective cases, when this therapy requires discontinuation, sirolimus, a mTOR inhibitor is used as an alternative immunosuppressant.4 5 We aimed to review our centre’s experience using sirolimus immunosuppression as an alternative to tacrolimus in paediatric LT recipients. A single centre retrospective review was performed on paediatric LT recipients who were started on sirolimus as an alternative immunosuppressive therapy to tacrolimus. Children who were on sirolimus between 2017 and 2023 were included in the study.A total of 16 children who underwent orthotopic liver transplantation (OLT) were started on sirolimus (median follow up time of 2.9 years (range 0.7–9.4)). There was equal gender distribution, the median age at time of OLT was 21.5 months (IQR 8.5,45) with sirolimus started at a median of 20 months (IQR 7.5,34) post OLT. The most common liver aetiology leading to transplant was Biliary Atresia (31.2%) followed by Progressive Familial Intrahepatic Cholestasis (25%). Post-Transplant Lymphoproliferative Disorder (PTLD) was the most common reason for tacrolimus discontinuation and conversion to sirolimus (n=11), followed by tacrolimus related adverse effects (n=4) and disease recurrence (n=1) (table 1). There were no cases of PTLD recurrence or biopsy confirmed rejection whilst on sirolimus. The most common side effect observed on sirolimus was proteinuria followed by hyperlipidaemia. Fifteen patients remain on sirolimus to date, and none required discontinuation due to side effects. Interestingly, in patients with PTLD, 3 episodes of rejection occurred between the period that tacrolimus was discontinued and sirolimus was started (median time off 82 days), with one child regrafted due to ensuing chronic rejection. All children remained on prednisolone maintenance immunosuppression during this wash-out period while PTLD resolved.In conclusion, the experience from our centre demonstrates sirolimus to be a safe and effective alternative to tacrolimus in a selected population of paediatric LT recipients. Further research with larger sample size is required to confirm these findings and evaluate the long-term safety of sirolimus in this population.Abstract OC8 Table 1Summary of patients‘ characteristics and variables exploring transition to sirolimus. *Combination of tacrolimus and prednisolone (12/16) OR ta