A Retrospective Review of Liver Transplant Patients Treated with Sirolimus from a Single Center: An Analysis of Sirolimus-Related Complications

Abstract

SRL is a powerful immunosuppressant but not devoid of side effects. These results have elevated our level of suspicion when instituting SRL and may help with early recognition and prevention of drug related complications.

Sirolimus-induced pneumonitis following liver transplantation

“…Other proposed benefits of sirolimus in LT include its putative antitumor properties for the management of patients transplanted for hepatocellular carcinoma 1 and its potential ability to attenuate graft injury in patients with hepatitis C. 2,3 Sirolimus, like other immunosuppressive agents, has a broad side-effect profile. 4 However, of particular concern is the increasingly recognized problem of sirolimus-induced pneumonitis, which is a well-described and potentially serious complication in renal transplantation. 5 Diagnosis of this complication can prove difficult as the clinical and pathological findings may be nonspecific.…”

Subclinical rejection and sirolimus associated edema in renal allograft recipients

“…That mTOR inhibitors could induce edema is supported by two additional observations. First, the bilateral lower extremity edema was found in 57.1% of liver transplants switched to SRL [9]. Unfortunately, proteinuria and renal function were not reported, which could be relevant taking into account the high incidence of 'silent' glomerulonephritis among HCV-infected liver allograft recipients [10].…”

Sirolimus-related anal ulceration in a female patient after allogeneic stem cell transplantation

“…[10][11][12] The most consistently reported mucocutaneous side effects in the SOT setting include acne-like eruptions, edemas, oral ulcerations and onychopathies. [4][5][6][7][8][9] We report here a case of a sirolimus-related anal ulceration without any other mucocutaneous lesion in a female patient after allo-SCT.…”

“…2 It can also be used to prevent or treat GVHD after allogeneic stem cell transplantation (allo-SCT). 3 The mucocutaneous side effects of sirolimus have been well described in renal [4][5][6] and liver [7][8][9] transplant recipients but are under-reported in the allo-SCT setting. [10][11][12] The most consistently reported mucocutaneous side effects in the SOT setting include acne-like eruptions, edemas, oral ulcerations and onychopathies.…”

“…[4][5][6][7][8][9] Three studies have reported on the toxicity of sirolimus after allo-SCT. [10][11][12] Renal insufficiency, hemolytic uremic syndrome, increases in cholesterol and triglyceride serum levels and hematological toxicity were common Figure 1.…”