Growing experience with mTOR inhibitors in pediatric solid organ transplantation

Controlled trials of mTOR 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 prospe...

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Bibliographic Details
Published in:Pediatric transplantation 2013-11, Vol.17 (7), p.694-706
Main Authors: 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.
Format: Article
Language:English
Subjects:
Calcineurin Inhibitors
Child
children
Everolimus
Fibrosis - pathology
Heart Transplantation
Humans
Immunosuppressive Agents - administration & dosage
Kidney Transplantation
Liver - pathology
Liver Transplantation
Lymphoproliferative Disorders - prevention & control
pediatric
Postoperative Complications - prevention & control
Risk
sirolimus
Sirolimus - administration & dosage
Sirolimus - analogs & derivatives
TOR Serine-Threonine Kinases - antagonists & inhibitors
transplantation
Treatment Outcome
Wound Healing
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Summary:Controlled trials of mTOR 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 mTOR inhibition following kidney, liver, or heart transplantation suggest preservation of immunosuppressive efficacy. Good renal function has been maintained when mTOR inhibitors are used de novo in children following kidney transplantation or after conversion to mTOR inhibition with CNI minimization. mTOR 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 mTOR inhibition, but more studies are required. No firm conclusions can be drawn as to whether mTOR inhibitors should be discontinued in children requiring surgical intervention or whether mTOR inhibition delays progression of hepatic fibrosis after pediatric liver transplantation. In conclusion, current evidence suggests that use of mTOR inhibitors in children undergoing solid organ transplantation is efficacious and safe, but a number of issues remain unresolved and further studies are required.
ISSN:1397-3142
1399-3046
DOI:10.1111/petr.12147