Adverse Effects of Mammalian Target of Rapamycin Inhibitors During the Postoperative Period After Cardiac Transplantation

Mammalian target of rapamycin (mTOR) inhibitors slow skin carcinogenesis, but impair wound healing

“…Six comparative studies have reported impaired wound healing in patients receiving everolimus/sirolimus after heart or kidney transplantation 7–12 . Other reports have confirmed this finding, 13 whereas the results of a randomized trial on kidney transplant recipients indicated that wound healing was similar at 3 months post‐transplant in the group with everolimus therapy from day 1 post‐transplant compared with the group on everolimus from week 5 14 . Similarly, the incidence of everolimus‐associated wound‐healing complications in de novo heart transplantation was not significantly increased compared with azathioprine 6 …”

Surgical wound complications after heart transplantation

“…Deep wound infections, including mediastinitis, are reported with incidences of 2.4% to 35% [5,21,[23][24][25]. Sternal dehiscence occurs in 12.5% to 25% of heart transplant recipients [7,26,27].…”

“…Two patients in the mTOR inhibitor group developed sternal dehiscence compared with none of the patients in the control group (22.2% vs. 0%, P = 0.09). One patient on everolimus required sternal reopening because of suspected mediastinitis [27].…”

Differential Effect of Everolimus on Progression of Early and Late Cardiac Allograft Vasculopathy in Current Clinical Practice

“…Our data additionally suggest that the protective effect of the mTOR inhibition may also be achieved by starting the drug slightly later after surgery. This concept may be of particular importance because a delayed start of everolimus may help to maintain efficacy while avoiding some of the side effects typical in the postoperative period (28)(29)(30).…”