title: Sirolimus-induced angioedema.
abstract: Sirolimus (SRL) is a macrolide immunosuppressant that has gained widespread use in organ transplantation. Its full spectrum of side-effects is yet to be defined. We describe herein three cases of SRL-induced angioedema (AE) in African-American (AA) primary renal allograft recipients who received SRL in combination with mycophenolate mofetil and steroids. In two cases, AE manifested after SRL was restarted after a period of discontinuation. The third case presented upon initial exposure to the drug. None of the patients was receiving any drug that has been previously associated with AE. Complete resolution occurred only after SRL was withdrawn. AE has not recurred in any of the patients during a follow-up period of up to 21 months. We conclude that AE is a previously unrecognized adverse event associated with SRL use. Close monitoring for this side-effect, especially in AA patients, is warranted.
authors.affiliation: Division of Nephrology, Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Hani
authors.initials: H
authors.lastname: Wadei
authors.forename: Scott A
authors.initials: SA
authors.lastname: Gruber
authors.forename: Jose M
authors.initials: JM
authors.lastname: El-Amm
authors.forename: James
authors.initials: J
authors.lastname: Garnick
authors.forename: Miguel S
authors.initials: MS
authors.lastname: West
authors.forename: Darla K
authors.initials: DK
authors.lastname: Granger
authors.forename: Dale H
authors.initials: DH
authors.lastname: Sillix
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Migdal
authors.forename: Abdolreza
authors.initials: A
authors.lastname: Haririan
mesh_terms: D001741:Black or African American; D000799:Angioedema / Q000139:chemically induced*; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D011182:Postoperative Care; D019233:Retreatment; D020123:Sirolimus / Q000009:adverse effects*; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D020123:Sirolimus