{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T00:08:10Z","timestamp":1754093290935,"version":"3.41.2"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"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":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Optimization of liver transplant (LT) immunosuppression is essential for long\u2010term graft function in children. Mammalian target of rapamycin (mTOR) inhibitors, such as sirolimus, have not been extensively studied in pediatric LT. We aimed to explore the usage of and indications for sirolimus at a quaternary pediatric LT center in a retrospective cohort analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Pediatric LT patients who received sirolimus from 2010 to 2018 were included. Their electronic medical records were evaluated for demographic information, clinical data, and laboratory data before and after initiation of sirolimus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sirolimus was initiated on 41 pediatric LT recipients at a median of 0.67 years post\u2010transplant (interquartile range [IQR]: 0.13\u20131.83) at Texas Children's Hospital. The leading indications for initiating sirolimus were chronic rejection (CR) (<jats:italic>n<\/jats:italic>\u2009=\u200912, 29.3%), T\u2010cell\u2010mediated rejection (TCMR) on tacrolimus (<jats:italic>n<\/jats:italic>\u2009=\u20098, 19.5%), posterior reversible encephalopathy syndrome (PRES) (<jats:italic>n<\/jats:italic>\u2009=\u20098, 19.5%), and unresectable hepatic tumors\/malignancies (<jats:italic>n<\/jats:italic>\u2009=\u20097, 17.1%). Among patients started on sirolimus for CR, 58% (<jats:italic>n<\/jats:italic>\u2009=\u20097\/12) demonstrated histological or biochemical improvement. Among those started for TCMR augmentation, 62.5% experienced biochemical improvement. No patients who started on sirolimus for unresectable hepatic tumors\/malignancies had malignancy recurrence 1\u2010year post\u2010LT. Median cholesterol and triglyceride levels 1\u2010year post\u2010initiation were higher than values 1\u2010year pre\u2010initiation (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001); however, sirolimus\u2010induced anemia, nephrotoxicity, and HAT were not observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study is among the first to review the clinical experience of sirolimus usage in pediatric LT. Our experience suggests sirolimus can be used safely and effectively. Further research is warranted to evaluate long\u2010term benefits, adverse effects, and optimal dosing of sirolimus in pediatric liver transplantation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jpn3.70073","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T05:19:22Z","timestamp":1747631962000},"page":"167-176","source":"Crossref","is-referenced-by-count":0,"title":["Sirolimus utilization in pediatric liver transplantation: A large high\u2010volume quaternary center experience"],"prefix":"10.1002","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0391-5543","authenticated-orcid":false,"given":"Wenly","family":"Ruan","sequence":"first","affiliation":[{"name":"Department of Pediatrics Baylor College of Medicine Houston Texas USA"},{"name":"Section of Pediatric Gastroenterology, Hepatology, and Nutrition Texas Children's Hospital Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana N.","family":"Cerminara","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Texas Children's Hospital Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nhu Thao Nguyen","family":"Galvan","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Texas Children's Hospital Houston Texas USA"},{"name":"Division of Abdominal Transplantation, Michael E. 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DeBakey Department of Surgery Baylor College of Medicine Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marielle","family":"Faraone","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Texas Children's Hospital Houston Texas USA"},{"name":"Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald T.","family":"Cotton","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Texas Children's Hospital Houston Texas USA"},{"name":"Division of Abdominal Transplantation, Michael E. 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DeBakey Department of Surgery Baylor College of Medicine Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel H.","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Baylor College of Medicine Houston Texas USA"},{"name":"Section of Pediatric Gastroenterology, Hepatology, and Nutrition Texas Children's Hospital Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"12","article-title":"An overview of immunosuppression in solid organ transplantation","volume":"21","author":"Enderby C","year":"2015","journal-title":"Am J Manag Care"},{"doi-asserted-by":"publisher","key":"e_1_2_7_3_1","DOI":"10.21037\/amj.2018.01.07"},{"doi-asserted-by":"publisher","key":"e_1_2_7_4_1","DOI":"10.1016\/S0041-1345(03)00217-3"},{"doi-asserted-by":"publisher","key":"e_1_2_7_5_1","DOI":"10.1016\/S0041-1345(03)00211-2"},{"unstructured":"Pfizer. 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