A retrospective review of sirolimus (repamune) therapy in orthotopic liver transplant recipients diagnosed with chronic rejection

Guy W. Neff, Marzia Montalbano, Gabriel Slapak-Green, Thierry Berney, Pablo A. Bejarano, Anand Joshi, Mike Icardi, Jose Nery, Seigo Nishida, David Levi, Debbie Weppler, Peter Pappas, Jose Ruiz, Eugene R Schiff, Andreas G. Tzakis

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Treatment options are limited for orthotopic liver transplant (OLT) recipients suffering from chronic rejection (CR). We performed a retrospective review of OLT recipients diagnosed with CR and treated with sirolimus. The medical records of all OLT recipients treated with sirolimus between October, 1998 and October, 2000 were retrospectively reviewed. The diagnosis of CR was made by both clinical and histologic criteria: bile duct to hepatic artery ratio less than 0.7, histologic activity index, hepatic arterial wall thickening, and chronic elevation of liver chemistries. Two groups were defined in regard to sirolimus response: sirolimus responders (SR) and sirolimus nonresponders (SNR). Response to treatment was granted only when patients were found to have resolution of abnormal liver transaminases and an improvement in hepatic artery to bile duct ratio. Serum collections for liver chemistries were collected on days 1, 30, 60, and 90. Liver biopsies were reviewed in blinded fashion from day 1 and at least 180 days on therapy by double-blinded pathologists. Sirolimus-related complications were recorded and include drug toxicity, anemia with and without treatment, hospitalizations, infections, immunosuppression complications, lipid profile disorders, edema, muscle aches, an gastrointestinal complaints. Twenty-one patients were diagnosed with CR. The SR group included 13 of 21, and 8 of 21 were in the SNR group. Anemia was diagnosed in 12 of 21 patients: SR, 7 of 13; SNR, 5 of 8; with 5 patients requiring red blood cell transfusions (2 SR, 3 SNR). Recombinant erythropoietin was started in 5 of 21 patients. Sirolimus serum levels were found to be greater than 20 ng/dL in 12 patients. Sirolimus was discontinued in 9 patients, (7 SR, 2 SNR primarily because of drug intolerance. The results show that sirolimus may help OLT recipients suffering from CR; however, a large number of patients experienced drug related side effects and were unable to tolerate therapy.

Original languageEnglish
Pages (from-to)477-483
Number of pages7
JournalLiver Transplantation
Volume9
Issue number5
DOIs
StatePublished - May 1 2003

Fingerprint

Sirolimus
Liver
Therapeutics
Transplant Recipients
Hepatic Artery
Bile Ducts
Drug-Related Side Effects and Adverse Reactions
Anemia
Erythrocyte Transfusion
Muscular Diseases
Erythropoietin
Transaminases
Serum
Immunosuppression

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Neff, G. W., Montalbano, M., Slapak-Green, G., Berney, T., Bejarano, P. A., Joshi, A., ... Tzakis, A. G. (2003). A retrospective review of sirolimus (repamune) therapy in orthotopic liver transplant recipients diagnosed with chronic rejection. Liver Transplantation, 9(5), 477-483. https://doi.org/10.1053/jlts.2003.50119

A retrospective review of sirolimus (repamune) therapy in orthotopic liver transplant recipients diagnosed with chronic rejection. / Neff, Guy W.; Montalbano, Marzia; Slapak-Green, Gabriel; Berney, Thierry; Bejarano, Pablo A.; Joshi, Anand; Icardi, Mike; Nery, Jose; Nishida, Seigo; Levi, David; Weppler, Debbie; Pappas, Peter; Ruiz, Jose; Schiff, Eugene R; Tzakis, Andreas G.

In: Liver Transplantation, Vol. 9, No. 5, 01.05.2003, p. 477-483.

Research output: Contribution to journalArticle

Neff, GW, Montalbano, M, Slapak-Green, G, Berney, T, Bejarano, PA, Joshi, A, Icardi, M, Nery, J, Nishida, S, Levi, D, Weppler, D, Pappas, P, Ruiz, J, Schiff, ER & Tzakis, AG 2003, 'A retrospective review of sirolimus (repamune) therapy in orthotopic liver transplant recipients diagnosed with chronic rejection', Liver Transplantation, vol. 9, no. 5, pp. 477-483. https://doi.org/10.1053/jlts.2003.50119
Neff, Guy W. ; Montalbano, Marzia ; Slapak-Green, Gabriel ; Berney, Thierry ; Bejarano, Pablo A. ; Joshi, Anand ; Icardi, Mike ; Nery, Jose ; Nishida, Seigo ; Levi, David ; Weppler, Debbie ; Pappas, Peter ; Ruiz, Jose ; Schiff, Eugene R ; Tzakis, Andreas G. / A retrospective review of sirolimus (repamune) therapy in orthotopic liver transplant recipients diagnosed with chronic rejection. In: Liver Transplantation. 2003 ; Vol. 9, No. 5. pp. 477-483.
@article{3f71227778c44c0aaba34d8cbff72c1e,
title = "A retrospective review of sirolimus (repamune) therapy in orthotopic liver transplant recipients diagnosed with chronic rejection",
abstract = "Treatment options are limited for orthotopic liver transplant (OLT) recipients suffering from chronic rejection (CR). We performed a retrospective review of OLT recipients diagnosed with CR and treated with sirolimus. The medical records of all OLT recipients treated with sirolimus between October, 1998 and October, 2000 were retrospectively reviewed. The diagnosis of CR was made by both clinical and histologic criteria: bile duct to hepatic artery ratio less than 0.7, histologic activity index, hepatic arterial wall thickening, and chronic elevation of liver chemistries. Two groups were defined in regard to sirolimus response: sirolimus responders (SR) and sirolimus nonresponders (SNR). Response to treatment was granted only when patients were found to have resolution of abnormal liver transaminases and an improvement in hepatic artery to bile duct ratio. Serum collections for liver chemistries were collected on days 1, 30, 60, and 90. Liver biopsies were reviewed in blinded fashion from day 1 and at least 180 days on therapy by double-blinded pathologists. Sirolimus-related complications were recorded and include drug toxicity, anemia with and without treatment, hospitalizations, infections, immunosuppression complications, lipid profile disorders, edema, muscle aches, an gastrointestinal complaints. Twenty-one patients were diagnosed with CR. The SR group included 13 of 21, and 8 of 21 were in the SNR group. Anemia was diagnosed in 12 of 21 patients: SR, 7 of 13; SNR, 5 of 8; with 5 patients requiring red blood cell transfusions (2 SR, 3 SNR). Recombinant erythropoietin was started in 5 of 21 patients. Sirolimus serum levels were found to be greater than 20 ng/dL in 12 patients. Sirolimus was discontinued in 9 patients, (7 SR, 2 SNR primarily because of drug intolerance. The results show that sirolimus may help OLT recipients suffering from CR; however, a large number of patients experienced drug related side effects and were unable to tolerate therapy.",
author = "Neff, {Guy W.} and Marzia Montalbano and Gabriel Slapak-Green and Thierry Berney and Bejarano, {Pablo A.} and Anand Joshi and Mike Icardi and Jose Nery and Seigo Nishida and David Levi and Debbie Weppler and Peter Pappas and Jose Ruiz and Schiff, {Eugene R} and Tzakis, {Andreas G.}",
year = "2003",
month = "5",
day = "1",
doi = "10.1053/jlts.2003.50119",
language = "English",
volume = "9",
pages = "477--483",
journal = "Liver Transplantation",
issn = "1527-6465",
publisher = "John Wiley and Sons Ltd",
number = "5",

}

TY - JOUR

T1 - A retrospective review of sirolimus (repamune) therapy in orthotopic liver transplant recipients diagnosed with chronic rejection

AU - Neff, Guy W.

AU - Montalbano, Marzia

AU - Slapak-Green, Gabriel

AU - Berney, Thierry

AU - Bejarano, Pablo A.

AU - Joshi, Anand

AU - Icardi, Mike

AU - Nery, Jose

AU - Nishida, Seigo

AU - Levi, David

AU - Weppler, Debbie

AU - Pappas, Peter

AU - Ruiz, Jose

AU - Schiff, Eugene R

AU - Tzakis, Andreas G.

PY - 2003/5/1

Y1 - 2003/5/1

N2 - Treatment options are limited for orthotopic liver transplant (OLT) recipients suffering from chronic rejection (CR). We performed a retrospective review of OLT recipients diagnosed with CR and treated with sirolimus. The medical records of all OLT recipients treated with sirolimus between October, 1998 and October, 2000 were retrospectively reviewed. The diagnosis of CR was made by both clinical and histologic criteria: bile duct to hepatic artery ratio less than 0.7, histologic activity index, hepatic arterial wall thickening, and chronic elevation of liver chemistries. Two groups were defined in regard to sirolimus response: sirolimus responders (SR) and sirolimus nonresponders (SNR). Response to treatment was granted only when patients were found to have resolution of abnormal liver transaminases and an improvement in hepatic artery to bile duct ratio. Serum collections for liver chemistries were collected on days 1, 30, 60, and 90. Liver biopsies were reviewed in blinded fashion from day 1 and at least 180 days on therapy by double-blinded pathologists. Sirolimus-related complications were recorded and include drug toxicity, anemia with and without treatment, hospitalizations, infections, immunosuppression complications, lipid profile disorders, edema, muscle aches, an gastrointestinal complaints. Twenty-one patients were diagnosed with CR. The SR group included 13 of 21, and 8 of 21 were in the SNR group. Anemia was diagnosed in 12 of 21 patients: SR, 7 of 13; SNR, 5 of 8; with 5 patients requiring red blood cell transfusions (2 SR, 3 SNR). Recombinant erythropoietin was started in 5 of 21 patients. Sirolimus serum levels were found to be greater than 20 ng/dL in 12 patients. Sirolimus was discontinued in 9 patients, (7 SR, 2 SNR primarily because of drug intolerance. The results show that sirolimus may help OLT recipients suffering from CR; however, a large number of patients experienced drug related side effects and were unable to tolerate therapy.

AB - Treatment options are limited for orthotopic liver transplant (OLT) recipients suffering from chronic rejection (CR). We performed a retrospective review of OLT recipients diagnosed with CR and treated with sirolimus. The medical records of all OLT recipients treated with sirolimus between October, 1998 and October, 2000 were retrospectively reviewed. The diagnosis of CR was made by both clinical and histologic criteria: bile duct to hepatic artery ratio less than 0.7, histologic activity index, hepatic arterial wall thickening, and chronic elevation of liver chemistries. Two groups were defined in regard to sirolimus response: sirolimus responders (SR) and sirolimus nonresponders (SNR). Response to treatment was granted only when patients were found to have resolution of abnormal liver transaminases and an improvement in hepatic artery to bile duct ratio. Serum collections for liver chemistries were collected on days 1, 30, 60, and 90. Liver biopsies were reviewed in blinded fashion from day 1 and at least 180 days on therapy by double-blinded pathologists. Sirolimus-related complications were recorded and include drug toxicity, anemia with and without treatment, hospitalizations, infections, immunosuppression complications, lipid profile disorders, edema, muscle aches, an gastrointestinal complaints. Twenty-one patients were diagnosed with CR. The SR group included 13 of 21, and 8 of 21 were in the SNR group. Anemia was diagnosed in 12 of 21 patients: SR, 7 of 13; SNR, 5 of 8; with 5 patients requiring red blood cell transfusions (2 SR, 3 SNR). Recombinant erythropoietin was started in 5 of 21 patients. Sirolimus serum levels were found to be greater than 20 ng/dL in 12 patients. Sirolimus was discontinued in 9 patients, (7 SR, 2 SNR primarily because of drug intolerance. The results show that sirolimus may help OLT recipients suffering from CR; however, a large number of patients experienced drug related side effects and were unable to tolerate therapy.

UR - http://www.scopus.com/inward/record.url?scp=0038782019&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0038782019&partnerID=8YFLogxK

U2 - 10.1053/jlts.2003.50119

DO - 10.1053/jlts.2003.50119

M3 - Article

C2 - 12740790

AN - SCOPUS:0038782019

VL - 9

SP - 477

EP - 483

JO - Liver Transplantation

JF - Liver Transplantation

SN - 1527-6465

IS - 5

ER -