title: Causes of sirolimus discontinuation in 97 liver transplant recipients.
abstract: BACKGROUND
  Sirolimus is a potent immunosuppressant with a mechanism of action different from calcineurin inhibitors (CNIs). It has increasing importance for liver transplant (OLT) patients, in particular if when there is decreased renal function. We evaluated the efficacy and the causes for discontinuation of sirolimus-based immunosuppression among OLT recipients.
  
  
  OBJECTIVE
  We retrospectively analyzed 97 liver transplanted patients who were prescribed sirolimus as the principal immunosuppressant. Of these, 61 patients discontinued treatment. Herein we have reported the causes, the timing, and the effects of sirolimus discontinuation.
  
  
  RESULTS
  The overall patient survival at 3 years follow-up was 89%. Hepatotoxicity and blood disorders were the most frequent, severe reported side effects. Acute cellular rejection episodes appeared in seven patients and was relieved in 1 to 2 weeks after the sirolimus administration. In 10 patients, the cholestasis associated with chronic rejection was sharply reduced after the introduction of sirolimus. No increase in vascular thrombosis and/or poor wound healing were reported.
  
  
  CONCLUSIONS
  Sirolimus given alone or in combination with CNIs appears to be an effective primary immunosuppressant regimen for OLT patients. However, in the late postoperative period (>3 months) the drug is associated with a relatively high rate of side effects.
authors.affiliation: Centre de Chirurgie Viscérale et de Transplantation-Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg-Université Louis Pasteur, Strasbourg, France.
authors.forename: F
authors.initials: F
authors.lastname: Panaro
authors.forename: T
authors.initials: T
authors.lastname: Piardi
authors.forename: F
authors.initials: F
authors.lastname: Gheza
authors.forename: B
authors.initials: B
authors.lastname: Ellero
authors.forename: M
authors.initials: M
authors.lastname: Audet
authors.forename: M
authors.initials: M
authors.lastname: Cag
authors.forename: J
authors.initials: J
authors.lastname: Cinqualbre
authors.forename: P
authors.initials: P
authors.lastname: Wolf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007558:Italy; D016031:Liver Transplantation / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects*; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus