Efficacy and safety of mammalian target of rapamycin inhibitors following intestinal and multivisceral transplantation

Krishna Modi, Maria Segovia, Alisha Mavis, Thomas Schiano, Yuval Patel, Justin Boike, Debra Sudan, Shunji Nagai, Syed Mohammed Jafri*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

This is a descriptive study reviewing the outcomes of mammalian target of rapamycin inhibitors (mTORs) in intestinal (IT) and multivisceral transplantation (MVT). This study included 22 patients, 20 adults, and two children, and an overall mean age of 46 years old at the time of transplantation. Twelve patients (54.5%) received IT, and the remainder (45.5%) MVT. The mean time between transplantation and mTORs initiation was 24 months. The indication was worsening renal function in 13 patients (59%), with 9/13 (69.2%) noted to have an increase in glomerular filtration rate of at least 10 ml/min/1.73m2. The indication for four patients (18.2%) was a history of neuroendocrine tumor. After mTOR initiation, 50% of patients were reduced or weaned off tacrolimus and 13.7% off prednisone. mTORs were discontinued in 11/22 patients. Six patients (54.5%) stopped due to side effects, two (18.1%) for surgery, and one (9%) for acute cellular rejection. Side effects were edema (33.3%), headaches (33.3%), diarrhea (16.7%), and oral ulcers (16.7%). The average duration of mTORs prior to discontinuation due to side effects was 7 months. mTORs may function in their own niche of patients due to the potential renal safety profile, but use is most limited by tolerance to side effects.

Original languageEnglish (US)
Article numbere14324
JournalClinical Transplantation
Volume35
Issue number7
DOIs
StatePublished - Jul 2021

Keywords

  • immunosuppressive regimens
  • intestinal failure/injury
  • intestine transplantation
  • mechanistic target of rapamycin (mTOR)
  • multivisceral transplantation

ASJC Scopus subject areas

  • Transplantation

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