Adverse effects of mammalian target of rapamycin inhibitors during the postoperative period after cardiac transplantation.
BACKGROUND
Safety of treatment with mammalian target of rapamycin inhibitors (mTORi) in the postoperative period after heart transplantation (HT) is controversial.


METHODS
We evaluated the incidence of postoperative complications (pericardial, pleural, and surgical wound complications) among nine de novo heart transplant recipients treated with mTORi compared with 19 patients who did not receive them during the same period (control group).


RESULTS
No significant differences were observed between the two groups regarding sex, age, body mass index, pretransplant diagnosis, history of diabetes mellitus, prior cardiac surgery, or baseline renal function. The main laboratory parameters at 1 month were also similar. During the first 2 months after HT, four patients (44%) in the mTORi group developed severe pericardial effusions requiring drainage, compared to 1 (5%) in the control group (P = .026). All patients presenting this complication in the mTORi group received everolimus. In addition, two cases of sternal dehiscence were observed in the mTORi group, compared to none in the control group (P = .09); one patient on everolimus required sternal reopening and debridement for clinically suspected mediastinitis. Duration of chest tube drainage, quantity of collected pleural fluid, and need for thoracentesis were similar in both groups.


CONCLUSIONS
In our series, patients receiving mTORi-particularly everolimus-during the postoperative period after HT showed a higher incidence of severe pericardial effusion requiring drainage, as well as a trend toward a higher incidence of sternal dehiscence, as compared to a group not receiving mTORi. The use of mTORi during the early postcardiac transplant period should be individualized.
Bouzas-Mosquera
A
A
Cardiac Transplant Unit, Area del Corazón, Complexo Hospitalario Universitario Juan Canalejo, A Coruña, Spain. aboumos@canalejo.org
Crespo-Leiro
M G
MG
Paniagua
M J
MJ
Naya
C
C
Grille
Z
Z
Marzoa
R
R
Barge-Caballero
E
E
Estévez-Cid
F
F
Alvarez-García
N
N
Cuenca
J J
JJ
Castro-Beiras
A
A
D000328:Adult; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010490:Pericardial Effusion / Q000453:epidemiology; D010996:Pleural Effusion / Q000453:epidemiology; D011184:Postoperative Period; D011494:Protein Kinases / Q000627:therapeutic use*; D012189:Retrospective Studies; D058570:TOR Serine-Threonine Kinases
D007166:Immunosuppressive Agents; D011494:Protein Kinases; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases