title: Wound healing complications with de novo sirolimus versus mycophenolate mofetil-based regimen in cardiac transplant recipients.
abstract: Sirolimus was introduced in de novo immunosuppression at Stanford University in view of its favorable effects on reduced rejection and cardiac allograft vasculopathy. After an apparent increase in the incidence of post-surgical wound complications as well as symptomatic pleural and pericardial effusions, we reverted to a mycophenolate mofetil (MMF)-based regimen. This retrospective study compared the outcome in heart transplant recipients on sirolimus (48 patients) with those on MMF (46 patients) in de novo immunosuppressive regimen. The incidence of any post-surgical wound complication (52% vs. 28%, p=0.019) and deep surgical wound complication (35% vs. 13%, p=0.012) was significantly higher in patients on sirolimus than on MMF. More patients on sirolimus also had symptomatic pleural (p=0.035) and large pericardial effusions (p=0.033) requiring intervention. Logistic regression analysis showed sirolimus (p=0.027) and longer cardiac bypass time (OR=1.011; p=0.048) as risk factors for any wound complication. Sirolimus in de novo immunosuppression after cardiac transplantation was associated with a significant increase in the incidence of post-surgical wound healing complications as well as symptomatic pleural and pericardial effusions.
authors.affiliation: Department of Cardiac Transplant, Stanford University Medical Center & Northern California Kaiser Permanente Heart Transplant Program, Stanford, CA, USA. sumans@yahoo.com
authors.forename: S
authors.initials: S
authors.lastname: Kuppahally
authors.forename: A
authors.initials: A
authors.lastname: Al-Khaldi
authors.forename: D
authors.initials: D
authors.lastname: Weisshaar
authors.forename: H A
authors.initials: HA
authors.lastname: Valantine
authors.forename: P
authors.initials: P
authors.lastname: Oyer
authors.forename: R C
authors.initials: RC
authors.lastname: Robbins
authors.forename: S A
authors.initials: SA
authors.lastname: Hunt
mesh_terms: D005260:Female; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology; D044469:Racial Groups; D012189:Retrospective Studies; D020123:Sirolimus / Q000009:adverse effects*; D014945:Wound Healing / Q000187:drug effects*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000276:immunology
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D020123:Sirolimus