Post-renal transplant surgical complications with newer immunosuppressive drugs: mycophenolate mofetil vs. m-TOR inhibitors.
OBJECTIVE
To compare the incidence of immediate surgical complications after renal transplantation between mycophenolate mofetil (MMF group)-based and mTOR inhibitors (mTOR group)-based immunosuppressive regimens.


METHODS
The preoperative parameters in the recipients, rejection rates and surgical complications within 12 months in the recipients were analyzed in 80 patients who had live related renal transplantation. The immunosuppressive regimen was based on MMF (MMF, prednisolone, cyclosporine) in 40 patients and mTOR inhibitors (sirolimus/everolimus, prednisolone, cyclosporine) in 40 patients.


RESULTS
The baseline characteristics were comparable between the two groups. Infective complications (urinary tract infections, pulmonary infections and superficial wound infection) occurred in 27.5% (11/40) and 12.5% (5/40) of patients from MMF and mTORI groups, respectively (P = 0.096). Patients in mTORI group had significantly more wound dehiscence (8/40 i.e., 20%) than in MMF group (1/40 i.e., 2.5%) (P = 0.014). There was no significant difference in the occurrence of clinically significant or symptomatic lymphoceles that needed intervention (3 vs. 2). The hospital stay was significantly prolonged in mTORI group mainly because of wound-related problems (35 vs. 24 days).


CONCLUSIONS
In the post-renal transplant setting, use of mTORI results in significantly higher wound complications compared to that of MMF leading to prolonged hospital stay. There is no significant difference in infective complications or lymphocele incidence between these two immunosuppressive regimens.
Srivastava
Aneesh
A
SGPGIMS, Lucknow, India. aneesh@sgpgi.ac.in
Muruganandham
K
K
Vinodh
P B
PB
Singh
Pratipal
P
Dubey
Deepak
D
Kapoor
Rakesh
R
Kumar
Anant
A
Sharma
Raj Kumar
RK
Prasad
Narayan
N
D000328:Adult; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D047908:Intracellular Signaling Peptides and Proteins / Q000037:antagonists & inhibitors*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D011183:Postoperative Complications / Q000139:chemically induced* / Q000453:epidemiology*; D011446:Prospective Studies; D017346:Protein Serine-Threonine Kinases / Q000037:antagonists & inhibitors*; D058570:TOR Serine-Threonine Kinases; D055815:Young Adult
D007166:Immunosuppressive Agents; D047908:Intracellular Signaling Peptides and Proteins; C546842:MTOR protein, human; D017346:Protein Serine-Threonine Kinases; D058570:TOR Serine-Threonine Kinases; D009173:Mycophenolic Acid