A retrospective review of liver transplant patients treated with sirolimus from a single center: an analysis of sirolimus-related complications.
BACKGROUND
Sirolimus (SRL) is a powerful immunosuppressant used primarily in calcineurin inhibitors (CNI)-related nephrotoxicity. However, reports of drug-related side effects are increasing. The aim of our report is to review the frequency and timing of these complications within our transplant patient population.


METHODS
We retrospectively reviewed the medical records of liver-transplanted patients treated with sirolimus between November 1998 and April 2002. The data collected included SRL serum levels, frequency of reported and documented SRL-related side effects, and survival outcomes. Statistical evaluation included Pearson chi-square and the Fisher's exact tests.


RESULTS
Overall, 205 patients were identified, with 30 patients removed from the analysis for different reasons. Of the remaining 175 patients, 91 (52%) patients developed a complication other than an increase in serum triglycerides and/or cholesterol. The most frequent complications were: bilateral lower extremity edema (57.1%), dermatitis (25.3%), oral ulcers (24.2%), joint pain (23.0%), pleural effusion (16.5%) and increase in abdominal girth (9.9%). Other complications included: generalized edema (5.5%), pericardial effusion (5.5%), facial edema (2.2%), and upper extremity edema (1.3%). In addition, we reported two cases of hepatic artery thrombosis, one case of wound dehiscence with evisceration that required surgical repair, and one case of skin cancer. Interestingly, we found that a previous history of myocardial ischemia correlates with the development of SRL side effects.


CONCLUSIONS
SRL is a powerful immunosuppressant but not devoid of side effects. These results have elevated our level of suspicion when instituting SRL and may help with early recognition and prevention of drug related complications.
Montalbano
Marzia
M
Division of Hepatology, Department of Medicine, University of Miami School of Medicine, Miami, FL, USA.
Neff
Guy W
GW
Yamashiki
Noriyo
N
Meyer
Douglas
D
Bettiol
Marina
M
Slapak-Green
Gabriella
G
Ruiz
Phillip
P
Manten
Emory
E
Safdar
Kamran
K
O'Brien
Christopher
C
Tzakis
Andreas G
AG
D004487:Edema / Q000139:chemically induced; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology*; D019226:Oral Ulcer / Q000139:chemically induced; D018579:Patient Selection; D011183:Postoperative Complications / Q000139:chemically induced / Q000276:immunology*; D012189:Retrospective Studies; D020123:Sirolimus / Q000009:adverse effects*
D007166:Immunosuppressive Agents; D020123:Sirolimus