{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T17:53:02Z","timestamp":1766339582617,"version":"3.33.0"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T00:00:00Z","timestamp":1720396800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study aimed to report our experience with the use of Sirolimus (SRL) in pediatric liver transplant patients with chronic rejection or steroid\u2010resistant rejection with hepatic fibrosis, focusing on their histological evolution. All pediatric liver transplant recipients who received off\u2010label treatment with SRL for chronic ductopenic rejection or cortico\u2010resistant rejection between July 2003 and July 2022 were included in the study. All nine patients included in the study showed improvement in liver enzymes and cholestasis parameters as soon as 1\u2010month after post\u2010SRL introduction. A decrease in fibrosis stage was observed in 7\/9 (77.7%) patients at 36 months. All but one patient experienced an improvement in the Rejection Activity Index and ductopenia at 12 months. A single patient had to discontinue SRL treatment owing to nephrotic proteinuria. In conclusion, SRL may be a safe and effective treatment for chronic and steroid\u2010resistant rejection and may improve allograft rejection\u2010related fibrosis and ductal damage.<\/jats:p>","DOI":"10.1002\/jpn3.12286","type":"journal-article","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T07:29:52Z","timestamp":1720423792000},"page":"962-968","source":"Crossref","is-referenced-by-count":6,"title":["Sirolimus to treat chronic and steroid\u2010resistant allograft rejection\u2010related fibrosis in pediatric liver transplantation"],"prefix":"10.1002","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6456-9031","authenticated-orcid":false,"given":"Jes\u00fas","family":"Quintero Bernabeu","sequence":"first","affiliation":[{"name":"Pediatric Hepatology and Liver Transplant Department, ERN Rare Liver \u2010 ERN TrasplantChild Hospital Universitari Vall d'Hebron Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Juamperez Go\u00f1i","sequence":"additional","affiliation":[{"name":"Pediatric Hepatology and Liver Transplant Department, ERN Rare Liver \u2010 ERN TrasplantChild Hospital Universitari Vall d'Hebron Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Mercadal Hally","sequence":"additional","affiliation":[{"name":"Pediatric Hepatology and Liver Transplant Department, ERN Rare Liver \u2010 ERN TrasplantChild Hospital Universitari Vall d'Hebron Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Padr\u00f3s Fornieles","sequence":"additional","affiliation":[{"name":"Pediatric Hepatology and Liver Transplant Department, ERN Rare Liver \u2010 ERN TrasplantChild Hospital Universitari Vall d'Hebron Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Ortega 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