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Angioedema in pediatric liver transplant recipients under tacrolimus immunosuppression
Panayotis Lykavieris1, Elisabeth Frauger, Dalila Habes
1Service d'Hépatologie pédiatrique, Hôpital de Bicêtre, Le Kremlin Bicêtre Cedex, France.
Insights
Tacrolimus may cause food-induced angioedema in pediatric liver transplant patients. Switching immunosuppression to cyclosporine may help manage this adverse reaction, allowing safe reintroduction of food allergens.
Area of Science:
- Pediatric Gastroenterology
- Transplant Immunology
- Allergy and Immunology
Background:
- Tacrolimus is a common immunosuppressant in pediatric liver transplant recipients.
- Food-induced angioedema is a potential adverse reaction.
- Understanding this association is crucial for patient management.
Purpose of the Study:
- To investigate the occurrence of food-induced angioedema in pediatric liver transplant recipients on tacrolimus.
- To evaluate the safety and efficacy of switching immunosuppression in managing this condition.
Main Methods:
- Retrospective analysis of 121 pediatric liver transplant recipients treated with tacrolimus.
- Identification of patients who developed angioedema related to food allergy.
- Comparison of outcomes after management changes, including switching to cyclosporine.
Main Results:
- 10% of patients (12 children) developed food-induced angioedema while on tacrolimus.
- Angioedema occurred at a mean age of 3.75 years, 28 months post-transplant.
- Switching to cyclosporine allowed successful reintroduction of food allergens in most cases.
Conclusions:
- A potential causal link between tacrolimus and food-induced angioedema is suggested.
- Switching from tacrolimus to cyclosporine is a viable management strategy.
- This approach may enable safe reintroduction of dietary triggers in affected children.
Background:
The authors report on their experience with food-induced angioedema in tacrolimus-immunosuppressed pediatric liver recipients.
Methods:
Among 121 children treated with tacrolimus after liver transplantation, those who presented with angioedema are reported.
Results:
Twelve children (10%) experienced angioedema related to food allergy while on tacrolimus. Mean ages at transplantation and angioedema were 1.3 years and 3.75 years, respectively. Angioedema occurred within a mean of 28 months from onset of tacrolimus. Eleven children experienced two or more angioedema attacks without consequences. One child presented with anaphylactic shock that caused postischemic cerebral damage. Besides eviction of food allergens, eight children were switched from tacrolimus to cyclosporine, whereas tacrolimus dosage was decreased in four. Reintroduction of food allergens was successfully performed only in those who were switched to cyclosporine.
Conclusion:
A causal relationship between tacrolimus and the occurrence of food-induced angioedema is suggested. The switch from tacrolimus to cyclosporine should be considered.