XXXX conversion therapy in pediatric liver transplantation.

@entity1 @entity851 @entity1071 @entity101 @entity229 @entity205 @entity134 @entity1140 @entity230 @entity3427
The safety and efficacy of conversion to @entity1140 after failing immunosuppression with @entity205 was prospectively evaluated in 31 pediatric liver transplant recipients between April 1991 and March 1993. The @entity1 , who ranged in age from 40 days to 14 years, accounted for 28 primary transplantations and 3 retransplantations. The initial immunosuppression regimen consisted of @entity205 in combination with @entity229 . The indications for conversion were acute or chronic rejection refractory to OKT3, Minnesota antilymphocyte globulin, or @entity230 (13 @entity1 ); @entity101 (8 @entity1 ); inability to reach a therapeutic level of @entity205 (6 @entity1 ); @entity3427 (3 @entity1 ); and @entity851 (1 @entity1 ). After an average follow-up of 10 months (range, 2 to 25 months), 27 (87%) of the @entity1 are alive and have functioning grafts. Of the 13 @entity1 who were converted for refractory rejection, 9 are alive. Six of these 9 @entity1 experienced a complete biochemical reversal of the rejection process within 3 months of conversion; 2 had a partial response to conversion, and 1 @entity1 failed but underwent successful retransplantation. Three of the 4 @entity1 who died did so without showing any improvement. The remaining 18 @entity1 who were converted for various other reasons are alive and have functioning grafts. Of the 8 @entity1 who developed @entity101 on @entity205 and @entity229 , 6 experienced a resolution of this problem within 3 months of conversion. Three of the 18 @entity1 who underwent rescue therapy for reasons other than refractory rejection experienced rejection episodes after conversion to @entity1140 . Two of these 3 @entity1 achieved resolution with either @entity134 therapy or an increased dosage of @entity1140 , while the third @entity1 developed chronic rejection. The side effects of @entity1140 were generally minor and resolved by lowering the dose. @entity1071 developed in 2 @entity1 (6%). The present study suggests that @entity1140 is a relatively safe and effective rescue therapy for pediatric liver transplant recipients who have failed immunosuppression with @entity205 . Longer follow-up is needed to assess the effect of @entity1140 on growth.
