title: Gastrointestinal hemorrhage due to complicated gastroduodenal ulcer disease in liver transplant patients taking sirolimus.
abstract: Sirolimus is emerging as a popular immunosuppressive agent for patients undergoing solid organ and pancreatic cell transplantation. Here, we report the clinical courses of three patients receiving sirolimus who developed aggressive gastroduodenal ulcer disease. One patient died from massive gastrointestinal bleeding, and ulcers in the other two patients healed only after discontinuation of sirolimus. We propose that the mechanism underlying this severe ulcer diathesis, and poor ulcer healing, was linked to the well-known inhibitory effects of sirolimus on wound healing. We propose that sirolimus should be used carefully (or even withheld) in patients with known or previous ulcer disease, and further that it should be used prudently and/or in conjunction with aggressive prophylaxis therapy in those at risk for ulcer disease.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Smith
authors.forename: Diane
authors.initials: D
authors.lastname: Bai
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Marroquin
authors.forename: Janet E
authors.initials: JE
authors.lastname: Tuttle-Newhall
authors.forename: Dev M
authors.initials: DM
authors.lastname: Desai
authors.forename: Bradley H
authors.initials: BH
authors.lastname: Collins
authors.forename: Andrew
authors.initials: A
authors.lastname: Muir
authors.forename: Paul C
authors.initials: PC
authors.lastname: Kuo
authors.forename: John
authors.initials: J
authors.lastname: McHutchison
authors.forename: Don C
authors.initials: DC
authors.lastname: Rockey
mesh_terms: D000328:Adult; D016903:Drug Monitoring; D004381:Duodenal Ulcer / Q000139:chemically induced*; D005260:Female; D005500:Follow-Up Studies; D006396:Hematemesis / Q000139:chemically induced; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016031:Liver Transplantation; D008297:Male; D008551:Melena / Q000139:chemically induced; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000139:chemically induced*; D020123:Sirolimus / Q000009:adverse effects*; D013276:Stomach Ulcer / Q000139:chemically induced*; D014945:Wound Healing / Q000187:drug effects
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus