Steroid withdrawal five days after renal transplantation allows for the prevention of wound-healing complications associated with sirolimus therapy.
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.
Sandrini
Silvio
S
Division of Nephrology, Department of Surgery, University and Spedali Civili, Brescia, Italy. sandrini.silvio@libero.it
Setti
Gisella
G
Bossini
Nicola
N
Maffei
Camilla
C
Iovinella
Lucia
L
Tognazzi
Nadia
N
Maffeis
Roberto
R
Nodari
Franco
F
Portolani
Nazario
N
Cancarini
Giovanni
G
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
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D020123:Sirolimus; D016559:Tacrolimus; D008775:Methylprednisolone