Center experience in liver transplantation (LTX): management of dermal side effects caused by sirolimus.
BACKGROUND
Sirolimus improves post transplant maintenance therapy in LTX. Dermal side effects causing pain and discomfort can limit patients' compliance. The package insert mentions such skin disorders as acne and rash. One case of sirolimus-induced leucocytoclastic vasculitis is reported in the literature.


METHODS
From July 1998 to October 2003, Sirolimus was implemented in the immunosuppressive protocol in 23 out of 60 liver recipients. Sirolimus target levels are between 3 and <10 ng/dl. Combination with a calcineurinblocker and/or MMF (mycophenolate mofetil) depending on liver function and creatinine is standard. Weekly patient monitoring in the first month after discharge included physical examination, blood samples and immunosuppresant trough levels. Biopsies were taken from untypical efflorescences.


RESULTS
Three patients with non-specific effloresces were reported: one with leucocytoclastic vasculitis and one with exfoliate forearm dermatitis required change of medication while one perivascular lymphocytic eosinophilic dermatitis subsided after dose reduction. In three cases of mouth ulcer, trough levels exceeded 10 ng/dl and in six patients acne diminished after dose reduction. Eighteen out of 23 patients are still receiving sirolimus. Reasons for removal from the study were incompliance and incompatibility. Two patients died.


CONCLUSIONS
Immunosuppressants inevitably produce side effects in TX recipients. The positive management of troublesome side effects contributes importantly to compliance and patient survival.
Schaffellner
S
S
Division of Transplantation Surgery, Department of Surgery, University Medical Center, Auenbruggerplatz 29, Postfach 50, 8036 Graz, Austria. silva.schaffellner@meduni-graz.at
Jakoby
E
E
Kniepeiss
D
D
Stadlbauer
V
V
Duller
D
D
Iberer
F
F
Tscheliessnigg
K H
KH
D000152:Acne Vulgaris; D000328:Adult; D000368:Aged; D003873:Dermatitis, Exfoliative; D003875:Drug Eruptions / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019226:Oral Ulcer / Q000209:etiology / Q000628:therapy; D020123:Sirolimus / Q000009:adverse effects*; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000209:etiology / Q000628:therapy
D007166:Immunosuppressive Agents; D020123:Sirolimus