Lung transplantation sirolimus

The most common adverse events reported with sirolimus are leukopenia (20%), thrombocytopenia (13% to 30%), and hyperlipidemia (38% to 57%).11,31 Other adverse effects include delayed wound healing, anemia, diarrhea, arthralgias, rash, and mouth ulcers. Sirolimus has an FDA black-box warning in newly transplanted liver and lung recipients.11 In liver transplant recipients, use of sirolimus immediately after transplant is associated with an increased risk of hepatic artery thrombosis, graft loss, and death. In lung transplant... 

Lung transplantation-bronchial anastomotic dehiscence Cases of bronchial anastomotic dehiscence, most fatal, have been reported in de novo lung transplant patients when sirolimus has been used as part of an immunosuppressive regimen. The safety and efficacy of sirolimus as immunosuppressive therapy have not been established in liver or lung transplant patients, and therefore, such use is not recommended. 

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. 

The majority (Knoop et al. 2003) of lung transplant recipients receive a triple-drug maintenance regimen including calcineurin inhibitors [CsA or tacrolimus (Tac)], cell-cycle inhibitors [mycophe-nolate mofetil (MMF), sirolimus, everolimus] and steroids (Fig. 5.1.3). Equal proportions receive CsA and Tac. There is also a trend to prescribe MMF instead of Aza. Steroid withdrawal is uncommon even 5 years after transplantation. The use of induction therapy with poly- or monoclonal antibodies is discussed controversially and differs between transplant centres. 

Respiratory Pulmonary alveolar proteinosis is a rare complication of treatment with sirolimus but has been reported in a 49-year-old female kidney transplant recipient [126 ]. A biopsy showed intact lung parenchyma and macrophages among alveoli filled with PAS-positive eosinophilic material which also stained positive for... 

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... 

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