title: Preliminary report of major surgery in liver transplant recipients receiving m-TOR inhibitors without therapeutic discontinuation.
abstract: BACKGROUND
  Mammalian target rapamycin inhibitors (m-TORi) are increasingly used in patients undergoing liver transplantation (LT). Yet, there is rising concern that they also could impair wound healing and favor the development of several surgical complications. This report was designed to evaluate both feasibility and safety of major surgery in liver transplant recipients receiving m-TORi-based immunosuppression without therapeutic discontinuation.
  
  
  METHODS
  From 2007 to 2012, six liver transplant recipients underwent nine major abdominal or thoracic surgical procedures without m-TORi discontinuation or specific dosage adjustment. Their characteristics and postoperative outcomes were retrospectively analyzed.
  
  
  RESULTS
  Indications for m-TORi were de novo or recurrent malignant disease in five patients and calcineurin inhibitors related neurologic toxicity in one patient. Abdominal procedures, thoracic procedures, and combined thoracic and abdominal procedures were performed in six, two, and one cases respectively. Emergency surgery was performed in one case and elective procedures were performed in eight cases, including five for malignant disease and three for late surgical complications following LT. No patient died postoperatively. One major complication was observed, but no patient required reoperation. No evisceration, incisional surgical site infection, or lymphocele occurred.
  
  
  CONCLUSIONS
  Major surgery in liver transplant recipients receiving m-TOR inhibitors appears both feasible and safe without therapeutic discontinuation or specific dosage adjustment.
authors: Department of Hepatobiliary and Liver Transplantation Surgery, Hopital Saint Antoine, Assistance publique-Hopitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012, Paris Cedex, France, lilian.schwarz@gmail.com.
authors: Lilian
authors: L
authors: Schwarz
authors: François
authors: F
authors: Cauchy
authors: Filomena
authors: F
authors: Conti
authors: Ailton
authors: A
authors: Sepulveda
authors: Fabiano
authors: F
authors: Perdigao
authors: Denis
authors: D
authors: Bernard
authors: Yvon
authors: Y
authors: Calmus
authors: Olivier
authors: O
authors: Soubrane
authors: Olivier
authors: O
authors: Scatton
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D000068338:Everolimus; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006500:Hepatic Duct, Common / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007583:Jejunum / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000517:prevention & control / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011013:Pneumonectomy / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*; D013908:Thoracotomy / Q000009:adverse effects; D066027:Transplant Recipients
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus