Growing experience with mTOR inhibitors in pediatric solid organ transplantation
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Growing experience with mTOR inhibitors in pediatric solid organ transplantation. / Ganschow, R; Pape, L; Sturm, E; Bauer, J; Melter, M; Gerner, P; Hoecker, B; Ahlenstiel, T; Kemper, M; Brinkert, F; Sachse, M M; Tönshoff, B.
In: PEDIATR TRANSPLANT, Vol. 17, No. 7, 01.11.2013, p. 694-706.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Growing experience with mTOR inhibitors in pediatric solid organ transplantation
AU - Ganschow, R
AU - Pape, L
AU - Sturm, E
AU - Bauer, J
AU - Melter, M
AU - Gerner, P
AU - Hoecker, B
AU - Ahlenstiel, T
AU - Kemper, M
AU - Brinkert, F
AU - Sachse, M M
AU - Tönshoff, B
N1 - © 2013 John Wiley & Sons A/S.
PY - 2013/11/1
Y1 - 2013/11/1
N2 - 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.
AB - 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.
KW - Calcineurin
KW - Child
KW - Fibrosis
KW - Heart Transplantation
KW - Humans
KW - Immunosuppressive Agents
KW - Kidney Transplantation
KW - Liver
KW - Liver Transplantation
KW - Lymphoproliferative Disorders
KW - Postoperative Complications
KW - Risk
KW - Sirolimus
KW - TOR Serine-Threonine Kinases
KW - Treatment Outcome
KW - Wound Healing
U2 - 10.1111/petr.12147
DO - 10.1111/petr.12147
M3 - SCORING: Journal article
C2 - 24004351
VL - 17
SP - 694
EP - 706
JO - PEDIATR TRANSPLANT
JF - PEDIATR TRANSPLANT
SN - 1397-3142
IS - 7
ER -