Impaired Lower Extremity Wound Healing Secondary to Sirolimus After Kidney Transplantation

DeVries, J. George; Collier, Rachel C.; Niezgoda, Jeffrey A.; Sanicola, Shawn M.; Simanonok, John P.

doi:10.1016/j.jcws.2009.06.001

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…These healing related complications are well documented in other surgical settings but have not been specifically tested in VCAs. Thus, these studies provide objective documentation that de novo sirolimus might be a particular risk for VCAs . As opposed to other solid organ transplants, in a skin‐containing VCA, the skin is a component of the transplant and the wound healing complications prevent engraftment.…”

Section: Discussionmentioning

confidence: 99%

Studies Introducing Costimulation Blockade for Vascularized Composite Allografts in Nonhuman Primates

Freitas

Samy

Farris

et al. 2015

American Journal of Transplantation

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Vascularized composite allografts (VCAs) are technically feasible. Similar to other organ transplants, VCAs are hampered by the toxicity and incomplete efficacy associated with conventional immunosuppression. Complications attributable to calcineurin inhibitors remain prevalent in the clinical cases reported to date, and these loom particularly large given the non-lifesaving nature of VCAs. Additionally, acute rejection remains almost ubiquitous, albeit controllable with current agents. Costimulation blockade offers the potential to provide prophylaxis from rejection without the adverse consequences of calcineurin-based regimens. In this study, we used a non-human-primate model of VCA in conjunction with immunosuppressive regimens containing combinations of B7-specific costimulation blockade with and without adhesion blockade with LFA3-Ig to determine what adjunctive role these agents could play in VCA transplantation when combined with more conventional agents. Compared to tacrolimus, the addition of belatacept improved rejection free allograft survival. The combination with LFA3-Ig reduced CD2hi memory T cells, however did not provide additional protection against allograft rejection and hindered protective immunity. Histology paralleled clinical histopathology and Banff grading. These data provide the basis for the study of costimulation blockade in VCA in a relevant preclinical model.

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Section: Discussionmentioning

confidence: 99%

Studies Introducing Costimulation Blockade for Vascularized Composite Allografts in Nonhuman Primates

Freitas

Samy

Farris

et al. 2015

American Journal of Transplantation

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“…Autologous platelet concentrate spray further enhanced granulation tissue formation leading to complete epithelialization of the wound after 4 wk[29]. In a similar situation, Devries et al[31] were unsuccessful in treating soft tissue infection on the leg of a KT recipient, that culminated in amputation. As the patient was on sirolimus, wound healing could have been compromised by the same drug[5,31,39].…”

Section: Resultsmentioning

confidence: 99%

Systematic review of the negative pressure wound therapy in kidney transplant recipients

Shrestha¹

2016

WJT

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AIMTo review negative pressure wound therapy (NPWT) as an important addition to the conventional methods of wound management.METHODSA systematic review, performed by searching the PubMed, EMBASE and Cochrane Library databases, showed 11 case reports comprising a total of 22 kidney transplantation (KT) patients (range, 1 to 9), who were treated with NPWT. Application of NPWT was associated with successful healing of wounds, leg ulcer, lymphocele and urine leak from ileal conduit.RESULTSNo complications related to NPWT were reported. However, there was paucity of robust data on the effectiveness of NPWT in KT recipients; therefore, prospective studies assessing its safety and efficacy of NPWT and randomised trials comparing the effectiveness of NPWT with alternative modalities of wound management in KT recipients is recommended.CONCLUSIONNegative pressure incision management system, NPWT with instillation and endoscopic vacuum-assisted closure system are in investigational stage.

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“…37 Sirolimus may predispose to wound complications, including deep infections, cellulitis, and fascial dehiscence. 38 Likewise, chronic corticosteroid use may be associated with a twofold to fivefold increase in wound complication rates. 39 However, we were unable to evaluate the risk in specific treatment regimens as the NIS database does not provide this detail.…”

Section: Discussionmentioning

confidence: 99%

Kidney-Pancreas Transplant Recipients Experience Higher Risk of Complications Compared to the General Population after Undergoing Coronary Artery Bypass Grafting

et al. 2021

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This retrospective analysis aims to identify differences in surgical outcomes between pancreas and/or kidney transplant recipients compared with the general population undergoing coronary artery bypass grafting (CABG). Using Nationwide Inpatient Sample (NIS) data from 2005 to 2014, patients who underwent CABG were stratified by either no history of transplant, or history of pancreas and/or kidney transplant. Multivariate analysis was used to calculate odds ratio (OR) to evaluate in-hospital mortality, morbidity, length of stay (LOS), and total hospital charge in all centers. The analysis was performed for both nonemergency and emergency CABG. Overall, 2,678 KTx (kidney transplant alone), 184 PTx (pancreas transplant alone), 254 KPTx (kidney-pancreas transplant recipients), and 1,796,186 Non-Tx (nontransplant) met inclusion criteria. KPTx experienced higher complication rates compared with Non-Tx (78.3 vs. 47.8%, p < 0.01). Those with PTx incurred greater total hospital charge and LOS. On weighted multivariate analysis, KPTx was associated with an increased risk for developing any complication following CABG (OR 3.512, p < 0.01) and emergency CABG (3.707, p < 0.01). This risk was even higher at transplant centers (CABG OR 4.302, p < 0.01; emergency CABG OR 10.072, p < 0.001). KTx was associated with increased in-hospital mortality following emergency CABG, while PTx and KPTx had no mortality to analyze. KPTx experienced a significantly higher risk of complications compared with the general population after undergoing CABG, in both transplant and nontransplant centers. These outcomes should be considered when providing perioperative care.

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Impaired Lower Extremity Wound Healing Secondary to Sirolimus After Kidney Transplantation

Cited by 4 publications

References 17 publications

Studies Introducing Costimulation Blockade for Vascularized Composite Allografts in Nonhuman Primates

Studies Introducing Costimulation Blockade for Vascularized Composite Allografts in Nonhuman Primates

Systematic review of the negative pressure wound therapy in kidney transplant recipients

Kidney-Pancreas Transplant Recipients Experience Higher Risk of Complications Compared to the General Population after Undergoing Coronary Artery Bypass Grafting

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