Successful resolution of inflammation and increased regulatory T cells in sirolimus-treated post-transplant allograft hepatitis

Udeme D. Ekong*, James Mathew, Hector Melin-Aldana, Deli Wang, Estella M. Alonso

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

This retrospective case series reviews our center's experience with sirolimus and a CNI as alternative therapy for the treatment of PTAH. It also characterizes regulatory T cells (Tregs) in PTAH. LT recipients with PTAH who had received or were receiving treatment with sirolimus were retrospectively identified (n = 12). Liver enzymes, immunohistochemistry, and histology were compared in all 12 patients. Immunophenotyping for Tregs in peripheral blood mononuclear cells was performed on LT recipients with PTAH on conventional therapy with CNI, azathioprine ± prednisone (CT) (n = 11), recipients with PTAH on sirolimus, CNI ± prednisone (n = 8), recipients without PTAH (n = 25), and pre-transplant patients (n = 5). Severity of necro-inflammatory changes markedly improved with sirolimus. Treg frequency and number were significantly lower in recipients with PTAH on CT compared to (i) those on sirolimus (p = 0.002 and p = 0.01, respectively), and (ii) recipients without PTAH (p = 0.07 and p = 0.009, respectively). Treg frequency was significantly higher in recipients with PTAH on sirolimus compared to recipients without PTAH under CNI therapy (p = 0.027). Sirolimus in addition to a CNI is successful in reversing inflammation in LT recipients with PTAH. This is associated with significantly higher circulating Tregs.

Original languageEnglish (US)
Pages (from-to)165-175
Number of pages11
JournalPediatric transplantation
Volume16
Issue number2
DOIs
StatePublished - Mar 1 2012

Keywords

  • chronic hepatitis
  • pediatric liver transplantation
  • regulatory T cells

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

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