title: Switching to sirolimus-based immune suppression after liver transplantation is safe and effective: a single-center experience.
abstract: BACKGROUND
  Sirolimus is unlicensed for use in liver transplantation because of concerns over safety, particularly in regard to hepatic artery thrombosis and excess mortality. However, sirolimus offers potential advantages over calcineurin inhibitor-based immunosuppression, relating to its renal sparing and antiproliferative properties.
  
  
  METHODS
  A review was undertaken of 148 liver transplant patients converted to sirolimus over 10 years at a single center.
  
  
  RESULTS
  The main indications for sirolimus were renal impairment and hepatitis C virus fibrosis. One hundred eleven (75%) patients remained on sirolimus after median follow-up of 1006 days. Mean (+/-standard deviation) glomerular filtration rate improved significantly from 59+/-29 mL/min preconversion to 72+/-39 mL/min at censor point (P<0.05). Improvement in glomerular filtration rate was most marked in patients converted for renal impairment. Liver function tests remained stable or improved, particularly in patients transplanted for hepatitis C virus. Side effects attributed to sirolimus occurred in 101 (68%) patients requiring withdrawal in 20 patients (14%). Moderate increases in serum lipids were observed and controlled effectively with statins. The incidence of proteinuria increased postconversion but had no deleterious impact on renal function. No episodes of hepatic artery thrombosis were observed.
  
  
  CONCLUSIONS
  Sirolimus was safe and may improve outcome in selected patients after liver transplantation.
authors: Department of Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom.
authors: Simon J  F
authors: SJ
authors: Harper
authors: William
authors: W
authors: Gelson
authors: Ines G
authors: IG
authors: Harper
authors: Graeme J M
authors: GJ
authors: Alexander
authors: Paul
authors: P
authors: Gibbs
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006526:Hepatitis C; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood; D008103:Liver Cirrhosis / Q000821:virology; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000139:chemically induced; D012189:Retrospective Studies; D020123:Sirolimus / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents; D008055:Lipids; D020123:Sirolimus