Comparison of Sirolimus vs. Mycophenolate Mofetil on Surgical Complications and Wound Healing in Adult Kidney Transplantation

Abstract

Mycophenolate mofetil (MMF) and sirolimus impair wound healing. We compared sirolimus vs. MMF to determine the relative impact on surgical complications and wound healing in adult kidney transplant recipients. This retrospective, single center study of 235 adult kidney transplants performed between 1 January 2000 and 31 January 2002 identified 158 adult, kidney‐only recipients treated with tacrolimus and prednisone, from which two groups were defined: group 1 (n = 84) received MMF, group 2 (n = 74) received sirolimus. The incidence of fluid collections, wound problems, dehiscence, and urine leak were compared. A multivariate stepwise logistical regression analysis was performed to identify risk factors. The overall incidence of complications was 21.5%, with rates significantly lower in group 1 (2.4%) vs. group 2 (43.2%, p < 0.0001). Regression analysis showed only sirolimus (p < 0.001) and hypo‐albuminemia (p = 0.006) to independently correlate with complication occurrence. In subanalyses, lymphoceles correlated only with sirolimus (p = 0.003), while other wound problems also correlated with higher body mass index (p = 0.067). The use of sirolimus, tacrolimus and prednisone was associated with a greater incidence of lymphoceles, non‐lymphocele perinephric fluid collections and other consequences of poor wound healing, as compared to contemporary patients treated with MMF, tacrolimus and prednisone.

Impaired Lower Extremity Wound Healing Secondary to Sirolimus After Kidney Transplantation

“…These cell lines are all essential to the formation of granulation tissue and propagation of the wound healing cascade. 11,12,16 One report reviewed a case of a clinically healed incision that was reopened 9 months later and revealed minimal degradation of absorbable suture material and a lack of mechanical strength of the fascial layer.…”

“…Superficial and deep wound infection, cellulitis, seroma formation, fascial dehiscence, and incisional hernias have all been linked to sirolimus. 11,12,13,14,15,16,17 The medical and surgical team caring for the patient must assess the risk-benefit ratio of sirolimus with close attention to the vast array of side effects in order to minimize potential complications. Various strategies have been employed to avoid potential problems.…”

Eficácia, tolerabilidade e segurança do uso do sirolimo após o transplante renal

“…19 Os efeitos do SRL sobre a cicatrização, de forma geral, e sobre a formação de linfocele, em particular, são reconhecidos e estão associados a suas propriedades antiproliferativas e seus efeitos inibitórios na angiogênese e na fibrose, interferindo com os mecanismos necessários para a cicatrização da ferida operatória. 20 A diversidade de indicações terapêuticas e de reações adversas dificulta a determinação da melhor forma de utilização clínica desse medicamento imunossupressor. 21 Rejeição aguda confirmada por biópsia (RACB) foi definida como toda disfunção aguda do enxerto cuja análise histológica da biópsia pôde ser classificada de acordo com os critérios de Banff, 1997.…”

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“…[1][2][3][4][5][6] Transplant patients are at higher risk for incisional hernias from long-term uremia, muscle, and tissue wasting and higher prevalence of obesity, diabetes, and chronic pulmonary diseases. [5][6][7] The effects of immunosuppression and renal transplant on wound healing have been welldocumented. [7][8][9][10][11][12][13][14][15][16][17][18] Corticosteroids play an important role in the development of incisional hernias by impeding wound healing.…”

“…[5][6][7] The effects of immunosuppression and renal transplant on wound healing have been welldocumented. [7][8][9][10][11][12][13][14][15][16][17][18] Corticosteroids play an important role in the development of incisional hernias by impeding wound healing. [8][9][10][11][12][13][14][15][16][17][18] During acute rejection, when higher doses of methylprednisolone (1 g/day) are administered, steroids have been shown to have considerable effects on the development of incisional hernias.…”