title: Sirolimus use and incidence of venous thromboembolism in cardiac transplant recipients.
abstract: Sirolimus is an immunosuppressive agent increasingly used in cardiac transplant recipients in the setting of allograft vasculopathy or worsening renal function. Recently, sirolimus has been associated with increased risk of venous thromboembolism (VTE) in lung transplant recipients. To investigate whether this association is also present in cardiac transplant recipients, we retrospectively reviewed the charts of 67 cardiac transplant recipients whose immunosuppressive regimen included sirolimus and 134 matched cardiac transplant recipients whose regimen did not include sirolimus. Rates of VTE were compared. Multivariable Cox proportional hazards models tested the association of sirolimus use with VTE. A higher incidence of VTE was seen in patients treated with vs. without sirolimus (8/67 [12%] vs. 9/134 [7%], log-rank statistic: 4.66, p=0.03). Lower body mass index (BMI) and total cholesterol levels were also associated with VTE (p<0.05). The association of sirolimus with VTE persisted when adjusting for BMI (hazard ratio [95% confidence interval]: 2.96 [1.13, 7.75], p=0.03) but not when adjusting for total cholesterol (p=0.08). These data suggest that sirolimus is associated with an increased risk of VTE in cardiac transplant recipients, a risk possibly mediated through comorbid conditions. Larger, more conclusive studies are needed. Until such studies are completed, a heightened level of awareness for VTE in cardiac transplant recipients treated with sirolimus appears warranted.
authors: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9047, USA.
authors: Jennifer T
authors: JT
authors: Thibodeau
authors: Joseph D
authors: JD
authors: Mishkin
authors: Parag C
authors: PC
authors: Patel
authors: Patricia A
authors: PA
authors: Kaiser
authors: Colby R
authors: CR
authors: Ayers
authors: Pradeep P A
authors: PP
authors: Mammen
authors: David W
authors: DW
authors: Markham
authors: W Steves
authors: WS
authors: Ring
authors: Matthias
authors: M
authors: Peltz
authors: Mark H
authors: MH
authors: Drazner
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology* / Q000209:etiology; D006331:Heart Diseases / Q000150:complications / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000009:adverse effects*; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus