Heart transplantation sirolimus

The impact of sirolimus on hormone concentrations involved in the hypothalamus-pituitary-gonad axis has been investigated in 132 male heart transplant recipients... 

Kaczmarek I, Groetzner J, Adamidis I, Landwehr P, Mueller M, Vogeser M, Gerstorfer M, Uberfuhr P, Meiser B, Reichart B. Sirolimus impairs gonadal function in heart transplant recipients. Am J Transplant 2004 4(7) 1084-8. 

Keogh A, Richardson M, Ruygrok R et al. Sirolimus in de novo heart transplant recipients reduces acute rejection and prevents coronary artery disease at 2 years a randomized clinical trial. Circulation 2004 I 0(l7) 2694-2700. 

Bestetti RB,TheodoropoulosTA, Burdmann LA, Santos MA,Abbud-FilhoM. Switch from cyclosporine to sirolimus as a treatment of acute renal failure complicating cardiogenic shock in a heart transplant recipient. Int J Cardiol 2006 112 e83-84. 

Clinical uses and pharmacokinetics Use of these immunosuppressants is a major factor in the success of solid organ transplantation. Cyclosporine is used in solid organ transplantation and in graft-versus-host syndrome in bone marrow transplants. Tacrolimus is used in liver and kidney transplant recipients and may be effective as rescue therapy in patients who fail standard therapy. Sirolimus is used alone or in combination with cyclosporine in kidney and heart transplantation. The agents, particularly cyclosporine, may also be effective in immune diseases, including rheumatoid arthritis, uveitis, psoriasis, asthma, and type 1 diabetes. 

A 2-year-old heart transplant patient given tacrolimus 0.02 mg/kg daily was given amiodarone to control ventricular arrhythmias. Her tacrolimus trough levels were reported as within target range of 8 to 10 micrograms/L on both day 1 and day 3 after starting the amiodarone. She was then switched from tacrolimus to sirolimus 0.06 mg/kg daily, increased to... 

Nalli N, Stewart-Texeira L, Dipchand AI. Amiodarone-sirolimus/tacrolimus interaction in a pediatric heart transplant patient Pediatr Transplant (2006) 10, 736-739. 

A case report describes a patient with a heart transplant who was given two doses of voriconazole 400 mg then 200 mg twice daily for 16 days. When sirolimus was started a dose of 1 mg gave a sirolimus trough level of 12.8 nanograms/mL, but after the voriconazole was stopped a dose of 3 mg only gave trough sirolimus levels of 7.4 nanograms/mL. Voriconazole has been seen to markedly raise sirolimus levels in a number of other patients. ... 

Mouth In four Japanese heart transplant recipients treated with everolimus, aphthous stomatitis necessitated dosage reductions in three and complete withdrawal in the other after a switch from mycophenolate mofetil [43 ]. Everolimus trough concentrations had not exceeded the target range at any time. They all recovered after dosage reduction or withdrawal. Aphthous stomatitis has been reported as an adverse reaction to sirolimus. 

Metabolism Before heart transplantation in 15 patients the mean concentration of serum triglycerides was 1.55 mmol/1 after transplantation it rose to 2.12 mmol/1 and after treatment with sirolimus or everolimus there was a further rise to 4.00 mmol/1 [31 ]. After treatment with omega-3 fatty acids for 4 months the triglyceride concentration fell to 2.55 mmol/1. 

Celik S, Doesch A, Erbel C, Blessing E, Ammon K, Koch A, Katus HA, Dengler TJ. Beneficial effect of omega-3 fatty acids on sirolimus- or everolimus-induced hypertriglyceridemia in heart transplant recipients. Transplantation 2008 86(2) 245-50. 

In a retrospective study of 548 heart transplant patients treated with sirolimus (34,3%) or everolimus (65.7%),... 

A retrospective study of lung and heart transplant patients who received sirolimus-based immunosuppression as a second-line agent after initial therapy with calcinemin inhibitors showed nine patients with cavitatory lung disease. Some patients showed complete resolution, whereas others had... 

Cyclosporine is an important drug in preventing rejection after kidney, hver, heart and other organ transplantation (Haberal et al., 2004). Cyclosporine usually is combined with other immunosuppressives especially glucocorticoids and either azathioprine or mycophenolate mofedl and sirolimus (Krensky et al., 2005). In renal alio transplants it has improved graft acceptance in most clinics to 95 percent. In addition to its use in transplantation cyclosporine is used for the treatment of a number of autoimmune diseases. In autoimmune diseases, as might be anticipated, cyclosporine is most effective in those which are T cell mediated. These include several forms of psoriasis, rheumatoid arthritis refractive to all other therapy, uveitis, nephrotic syndrome and type I diabetes mellitus. 

Meiser B, Kaczmarek I, Mueller M, Groetzner J, Weis M, Knez A, Stempfle FlU, Klauss V, Schmoeckel M, Reichart B, Ueberfuhr P. Low-dose tacrolimus/sirolimus and steroid withdrawal in heart recipients is highly efficacious. J Heart Lung Transplant 2007 ... 

Cahill BC, Somerville T, Karwande SW, et al. Early experience with sirolimus in lung transplant recipients with chronic allograft rejection. J Heart Lung Transplant 2003 22 169-176. 

Baneq ee SK, Santhanakrishnan K, Tsui S, Parameshwar J, Parmar J. Cavitatory lung disease in thoracic transplant recipients receiving sirolimus. J Heart Lung Transplant May 2012 31(5) 548-51. PubMed PMID 22397867. Epub 2012/03/09. eng. 

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