Immunosuppression in infants with short bowel syndrome undergoing isolated liver transplantation

Area of Science:

• Pediatric Gastroenterology
• Hepatology
• Transplantation Immunology

Background:

• Limited data exists on immunosuppressive drug absorption in pediatric patients with short bowel syndrome and intestinal failure-associated liver disease (SBS-IFALD).
• Assessing drug absorption is crucial for managing immunosuppression post-liver transplantation in this vulnerable population.

Purpose of the Study:

• To evaluate the absorption of immunosuppressive medications, specifically tacrolimus, in children with SBS-IFALD undergoing isolated liver transplantation (iLTx).
• To compare tacrolimus absorption and clinical outcomes in children with SBS-IFALD versus those with extra-hepatic biliary atresia (EHBA).

Main Methods:

• Retrospective review of pediatric patients undergoing iLTx.
• Comparison between children with SBS-IFALD and weight/age-matched controls with EHBA and normal intestinal function.
• Analysis of tacrolimus trough levels, dose-normalized concentrations, and acute rejection rates at 3, 6, and 12 months post-transplant.

Main Results:

• Children with SBS-IFALD had lower initial trough tacrolimus levels at 3 and 6 months post-iLTx compared to EHBA controls.
• However, dose-normalized concentrations indicated comparable systemic availability of tacrolimus between the groups at 3, 6, and 12 months.
• The incidence of acute rejection was low in the SBS-IFALD group (1/7) versus the EHBA group (10/15), though not statistically significant (p=0.06).

Conclusions:

• Pediatric patients with SBS-IFALD demonstrate adequate oral tacrolimus absorption following iLTx.
• Standard immunosuppression regimens appear effective, as evidenced by comparable drug bioavailability and low acute rejection rates.
• Modification of immunosuppression is likely not required for children with SBS-IFALD post-iLTx.