{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T01:04:00Z","timestamp":1773968640251,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2013,10,6]],"date-time":"2013-10-06T00:00:00Z","timestamp":1381017600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Sirolimus is used in heart transplant patients with CAV and CNI\u2010induced nephropathy. However, little is known regarding the tolerability, rejection rate, and effect on renal function when used empirically in children. We describe our experience with the empiric use of a sirolimus\u2010based immunosuppressive regimen in pediatric heart transplantation recipients. We reviewed records of patients in whom conversion was attempted to a CNI\u2010free sirolimus\u2010based regimen. Rejection episodes and measures of renal function were recorded. We attempted to convert 20 patients, of which 16 were successful. In total, six of 20 patients (30%) experienced adverse effects. Of the 16 converted, four patients converted to sirolimus due to CNI\u2010induced disease (three nephropathy, one CAV), while 12 patients (mean age 5.5\u00a0yr, range 0.1\u201321\u00a0yr; 33% female; 33% with a history of congenital heart disease) were empirically switched to sirolimus at a mean of 2.3\u00a0yr after transplant. Follow\u2010up was available for a mean of 2.5\u00a0yr after conversion (range 0.5\u20138.3\u00a0yr). The rate of rejection while taking CNIs was 0.18 rejection episodes per patient\u2010year (total of five episodes), compared with 0.03 rejection episodes per patient\u2010year (total of one episode) while on sirolimus. Renal function, in terms of GFR, significantly improved after sirolimus conversion at latest follow\u2010up (from 86\u00a0\u00b1\u00a037\u00a0mL\/min to 130\u00a0\u00b1\u00a049\u00a0mL\/min, p\u00a0=\u00a00.02). Here, we demonstrate the potential benefit of empiric use of sirolimus in pediatric heart transplant patients in a CNI\u2010free regimen. Larger and longer studies are needed to further clarify risks of rejection and adverse effect profiles.<\/jats:p>","DOI":"10.1111\/petr.12163","type":"journal-article","created":{"date-parts":[[2013,10,28]],"date-time":"2013-10-28T07:04:12Z","timestamp":1382943852000},"page":"794-799","source":"Crossref","is-referenced-by-count":21,"title":["Empiric switch from calcineurin inhibitor to sirolimus\u2010based immunosuppression in pediatric heart transplantation recipients"],"prefix":"10.1111","volume":"17","author":[{"given":"Robert W.","family":"Loar","sequence":"first","affiliation":[{"name":"Pediatric and Adolescent Medicine Mayo Clinic Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Driscoll","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Mayo Clinic Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudhir S.","family":"Kushwaha","sequence":"additional","affiliation":[{"name":"Cardiovascular Diseases Mayo Clinic Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl H.","family":"Cramer","sequence":"additional","affiliation":[{"name":"Pediatric Nephrology Mayo Clinic Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick W.","family":"O'Leary","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Mayo Clinic Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard C.","family":"Daly","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery Mayo Clinic Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel A.","family":"Mauriello","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Mayo Clinic Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan 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