Sirolimus as the main immunosuppressant in the early postoperative period following liver transplantation: a report of six cases and review of the literature.
The use of sirolimus as the main immunosuppressant in a calcineurin inhibitor-free regimen in the early postoperative period of liver transplantation (LT), when the incidence of rejection is the highest, has seldom been reported. We report six patients who received sirolimus in association with steroids only, at a median time of 10 days after LT (range 3-23). Tacrolimus, initially given as the standard immunosuppressant, was discontinued because of nephrotoxicity in three of these patients and neurotoxicity in the other three. Resolution of the neurological symptoms was observed in all cases and a marked improvement of the renal function in two of three patients. Two patients died, one of sepsis and the other of recurrent hepatitis C virus hepatitis, after 47 and 143 days respectively. Three patients developed acute rejection which responded to intravenous steroids. In this cohort of patients, the use of sirolimus appeared safe and provided an adequate prophylaxis against rejection, even though the drug was administered in the immediate postoperative period after LT.
Vivarelli
Marco
M
Department of Surgery and Transplantation, University of Bologna, S. Orsola Hospital, Bologna, Italy. vivarelli@aosp.bo.it
Vetrone
Gaetano
G
Zanello
Matteo
M
La Barba
Giuliano
G
Cucchetti
Alessandro
A
Lauro
Augusto
A
Grazi
Gian Luca
GL
Pinna
Antonio Daniele
AD
D000368:Aged; D065095:Calcineurin Inhibitors; D005260:Female; D006526:Hepatitis C / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D020123:Sirolimus / Q000627:therapeutic use*
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D020123:Sirolimus