{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T15:03:47Z","timestamp":1789830227316,"version":"4.0.1"},"reference-count":13,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2017,8,12]],"date-time":"2017-08-12T00:00:00Z","timestamp":1502496000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>There are only a few reports of successful use of mammalian target of rapamycin (<jats:styled-content style=\"fixed-case\">mTORI<\/jats:styled-content>) as primary immunosuppression in pediatric heart transplantation. Compared to calcineurin inhibitors, <jats:styled-content style=\"fixed-case\">mTORI<\/jats:styled-content> have less side effects, especially nephrotoxicity, infections, and malignancies. A retrospective study was conducted at our institution of all 170 heart transplants from 1995 to 2015. Nineteen patients were switched from tacrolimus (n=15) or cyclosporin (n=4) to everolimus (n=4) or sirolimus (n=15) due to nephrotoxicity (n=5), malignancy (n=8), <jats:styled-content style=\"fixed-case\">EBV<\/jats:styled-content> viremia\/reactive plasmacytic changes (n=5), and immune hemolytic anemia (n=1). We monitored for rejection, infection, <jats:styled-content style=\"fixed-case\">BUN<\/jats:styled-content>, creatinine, hyperlipidemia, <jats:styled-content style=\"fixed-case\">EBV<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">CMV<\/jats:styled-content> copies, <jats:styled-content style=\"fixed-case\">CBC<\/jats:styled-content>, cardiac allograft vasculopathy (<jats:styled-content style=\"fixed-case\">CAV<\/jats:styled-content>), and death. Target trough levels of sirolimus and everolimus were 4\u201010. Four treatment failures included debilitating rash, bone marrow suppression, recurrent rejection, and renal transplantation. There were no deaths. One patient had recurrent rejection episodes, and tacrolimus was reinitiated. One patient with preexisting <jats:styled-content style=\"fixed-case\">CAV<\/jats:styled-content> underwent heart retransplantation. One patient, who was treated for <jats:styled-content style=\"fixed-case\">PTLD<\/jats:styled-content>, transformed to <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>30+ Hodgkins disease, and was treated with brentuximab. There were three acute rejection episodes. Median creatinine preswitch was higher 0.82 than postswitch 0.78 (<jats:italic>P<\/jats:italic>=.016). Median <jats:styled-content style=\"fixed-case\">eGFR<\/jats:styled-content> was lower preswitch, 75.6, than postswitch, 91.2\u00a0(<jats:italic>P<\/jats:italic>=.0004). These results indicate that conversion to <jats:styled-content style=\"fixed-case\">mTORI<\/jats:styled-content> as primary immunosuppression may be safely accomplished in some pediatric heart transplant patients.<\/jats:p>","DOI":"10.1111\/ctr.13054","type":"journal-article","created":{"date-parts":[[2017,7,14]],"date-time":"2017-07-14T14:52:39Z","timestamp":1500043959000},"source":"Crossref","is-referenced-by-count":19,"title":["Conversion from calcineurin inhibitors to <scp>mTOR<\/scp> inhibitors as primary immunosuppressive drugs in pediatric heart transplantation"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3621-2246","authenticated-orcid":false,"given":"Alfred","family":"Asante\u2010Korang","sequence":"first","affiliation":[{"name":"Divisions of Cardiology Johns Hopkins All Children's Hospital  St Petersburg FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Carapellucci","sequence":"additional","affiliation":[{"name":"Divisions of Cardiology Johns Hopkins All Children's Hospital  St Petersburg FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Krasnopero","sequence":"additional","affiliation":[{"name":"Divisions of Cardiology Johns Hopkins All Children's Hospital  St Petersburg FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"Doyle","sequence":"additional","affiliation":[{"name":"Divisions of Cardiology Johns Hopkins All Children's Hospital  St Petersburg FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Brown","sequence":"additional","affiliation":[{"name":"Pharmacy Johns Hopkins All Children's Hospital  St Petersburg FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest","family":"Amankwah","sequence":"additional","affiliation":[{"name":"Center for Translational Research Johns Hopkins All Children's Hospital  St Petersburg FL USA"},{"name":"Hematology Oncology Johns Hopkins All Children's Hospital  St Petersburg FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,8,12]]},"reference":[{"issue":"1","key":"e_1_2_7_2_1","first-page":"1","article-title":"Conversion to mTOR\u2010inhibitor\u2010based immunosuppression: which patients and when?","volume":"2","author":"Philippe G","year":"2013","journal-title":"Transplant 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