title: Comparison of sirolimus vs. mycophenolate mofetil on surgical complications and wound healing in adult kidney transplantation.
abstract: Mycophenolate mofetil (MMF) and sirolimus impair wound healing. We compared sirolimus vs. MMF to determine the relative impact on surgical complications and wound healing in adult kidney transplant recipients. This retrospective, single center study of 235 adult kidney transplants performed between 1 January 2000 and 31 January 2002 identified 158 adult, kidney-only recipients treated with tacrolimus and prednisone, from which two groups were defined: group 1 (n = 84) received MMF, group 2 (n = 74) received sirolimus. The incidence of fluid collections, wound problems, dehiscence, and urine leak were compared. A multivariate stepwise logistical regression analysis was performed to identify risk factors. The overall incidence of complications was 21.5%, with rates significantly lower in group 1 (2.4%) vs. group 2 (43.2%, p < 0.0001). Regression analysis showed only sirolimus (p < 0.001) and hypo-albuminemia (p = 0.006) to independently correlate with complication occurrence. In subanalyses, lymphoceles correlated only with sirolimus (p = 0.003), while other wound problems also correlated with higher body mass index (p = 0.067). The use of sirolimus, tacrolimus and prednisone was associated with a greater incidence of lymphoceles, non-lymphocele perinephric fluid collections and other consequences of poor wound healing, as compared to contemporary patients treated with MMF, tacrolimus and prednisone.
authors.affiliation: Department of Surgery, Division of Nephrology, University Hospitals of Cleveland, Cleveland, OH, USA. John.valente@uhhs.com
authors.forename: John F
authors.initials: JF
authors.lastname: Valente
authors.forename: Donald
authors.initials: D
authors.lastname: Hricik
authors.forename: Kelly
authors.initials: K
authors.lastname: Weigel
authors.forename: David
authors.initials: D
authors.lastname: Seaman
authors.forename: Thomas
authors.initials: T
authors.lastname: Knauss
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Siegel
authors.forename: Kenneth
authors.initials: K
authors.lastname: Bodziak
authors.forename: James A
authors.initials: JA
authors.lastname: Schulak
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D020123:Sirolimus