I am 5 yrs post liver transplant (fatty liver cirrhosis). I want to make a case to my xplant DRs for switching to Sirolimus. mTOR inhibitors can suppress t cell proliferation (like tacrolimus, a calcinurine inhibitor does), but at some (other?) dosing, they promote reorganizing the relationship of t-reg cells and dendritic cells to create transplant tolerance. And, as in the 2014 Joan Mannic MD / Novartis study, they can improve vaccine response and reduce illness in clinical trials.
Moreover, I think my own post xplant diet, fasting, and exercise lifestyle has become one of frequent mTOR suppression, which should be a great starting place for this drug switch (in fact, my liver enzymes are so good, I think I’ve achieved tolerance already).
Does anyone know what “professional” literature I can point my DRs to that discusses the continuum between Immune suppression and transplant tolerance as a function of rapalog dosing?