Multicentric outcome analysis of sirolimus-based immunosuppression in 252 liver transplant recipients
- 1 February 2010
- journal article
- research article
- Published by Frontiers Media SA in Transplant International
- Vol. 23 (2), 155-168
- https://doi.org/10.1111/j.1432-2277.2009.00969.x
Abstract
The use of sirolimus (SRL) in orthotopic liver transplantation (OLT) has been controversial after experimental data suggested an increased risk of hepatic artery thrombosis (HAT). To assess the safety and efficacy of SRL as de novo immunosuppression in OLT recipients. Outcomes of 252 OLT patients who received SRL were compared with outcomes of 291 OLT recipients who received calcineurin inhibitor in a retrospective study. Primary outcomes of this study were: patient- and graft survivals, vascular, biliary, wound complications and rejection rates. Secondary outcomes were: postoperative infection rate, bone marrow and renal function and changes of lipid levels. Patient- and graft survivals, rejection and infection rates were similar. In the SRL group, HAT occurred in 1.2%, biliary complications in 19.4%, and incisional hernias in 9.1%. In the control group the incidence of HAT was 5.8% (P = 0.004), biliary complications 18.5% (P = NS) and incisional hernias 7.2% (P = NS). Patients on SRL experienced significantly higher levels of serum triglycerides but fewer acute cellular rejections. Bone marrow and renal functions were similar in both the groups. Our findings would suggest that SRL is safe and effective for very selected OLT recipients. Randomized controlled trials are necessary to confirm our results.Keywords
This publication has 70 references indexed in Scilit:
- Contemporary Management of Uncomplicated Urinary Tract InfectionsDrugs, 2008
- Survival after liver transplantation in the United Kingdom and Ireland compared with the United StatesGut, 2007
- Can the Clinical Pulmonary Infection Score Impact ICU Antibiotic Days?Surgical Infections, 2006
- Acute Renal Failure Requiring Renal Replacement Therapy After Orthotopic Liver TransplantationTransplantation Proceedings, 2006
- Posttransplantation chronic renal damage in nonrenal transplant recipientsKidney International, 2005
- Chronic Renal Failure after Transplantation of a Nonrenal OrganNew England Journal of Medicine, 2003
- Orthotopic liver transplantation using low-dose tacrolimus and sirolimusLiver Transplantation, 2001
- Cytomegalovirus infection and disease after liver transplantationDigestive Diseases and Sciences, 1992
- The effect of rapamycin on renal function in the rat: a comparative study with cyclosporineToxicology Letters, 1991
- Liver Transplantation with Use of Cyclosporin a and PrednisoneNew England Journal of Medicine, 1981