title: Steroid withdrawal five days after renal transplantation allows for the prevention of wound-healing complications associated with sirolimus therapy.
abstract: BACKGROUND
  Sirolimus (SRL) can increase the risk of wound complications. In this study, we investigated the impact of steroids when added to SRL, in this side effect.
  
  
  METHODS
  One hundred and forty-eight patients entered prospective studies comparing early (fifth day) with late (sixth month) steroid withdrawal. All patients were on SRL, added either to Tacrolimus (n = 56) or to cyclosporine (n = 97). At 15th day after transplantation, 68 patients were on steroids (On-St group) and 80 were not (Off-St group). Wound complications considered were as follows: dehiscence, lymphocele, wound leakage, hematoma and seromas. Risk factors under analysis were as follows: body mass index, diabetes, rejection, creatininemia, length of dialysis before transplantation, recipient age, being on steroids at 15th day, SRL levels.
  
  
  RESULTS
  The overall incidence of wound complications was significantly lower in Off-St group than in On-St group: 18.8% vs. 45.6%, respectively (p < 0.0004). In detail, lymphocele: 5.0% vs. 32.3% (p < 0.0001); dehiscence 0% vs. 10.3% (p < 0.009), leakage 6.2% vs. 8.8% (p = NS), seromas 1.4% vs. 7.5% (NS). At multivariate analysis, the addition of steroids to SRL increases 4.2-fold the risk for wound complications.
  
  
  CONCLUSIONS
  Early steroid withdrawal is effective in preventing both the incidence and the severity of wound-healing complications because of SRL regime, even when started with a loading dose.
authors: Division of Nephrology, Department of Surgery, University and Spedali Civili, Brescia, Italy. sandrini.silvio@libero.it
authors: Silvio
authors: S
authors: Sandrini
authors: Gisella
authors: G
authors: Setti
authors: Nicola
authors: N
authors: Bossini
authors: Camilla
authors: C
authors: Maffei
authors: Lucia
authors: L
authors: Iovinella
authors: Nadia
authors: N
authors: Tognazzi
authors: Roberto
authors: R
authors: Maffeis
authors: Franco
authors: F
authors: Nodari
authors: Nazario
authors: N
authors: Portolani
authors: Giovanni
authors: G
authors: Cancarini
mesh_terms: D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000627:therapeutic use*; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects* / Q000276:immunology
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D020123:Sirolimus; D016559:Tacrolimus; D008775:Methylprednisolone