Risk Factors for Wound Healing Complications in Sirolimus-Treated Renal Transplant Recipients

Grim, Shellee A.; Slover, Christine M.; Sankary, Howard; Oberholzer, José; Benedetti, Enrico; Clark, Nina M.

doi:10.1016/j.transproceed.2006.10.065

Cited by 45 publications

(51 citation statements)

References 13 publications

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“…Different factors have been investigated in various studies as the responsible factors for wound healing complications such as immunosupressant agents, steroids, elevated BMI, smoking and rejection episodes. For the drugs as a major risk factor, it is thought that wound healing disturbance occurs due to antiproliferative effects of drugs which impair fibroblasts function [3-5,13,14,17,24-26]. …”

Section: Discussionmentioning

confidence: 99%

“…4.5% in non-ATG group); among them, lymphocele was the most frequent complications recorded. Grim, et al [14], determined the incidence of surgical site complications among renal transplant recipients who received sirolimus with MMF. They reported an incidence of 31.8% for wound healing complications with the highest incidence for wound dehiscence.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

UP-03.034 Is There a Relation Between Post Kidney Transplantation Antithymocyte Globulin Therapy and Wound Healing Disturbance?

Pourmand

Saraji

Dehghani

et al. 2011

Urology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

UP-03.034 Is There a Relation Between Post Kidney Transplantation Antithymocyte Globulin Therapy and Wound Healing Disturbance?

Pourmand

Saraji

Dehghani

et al. 2011

Urology

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“…9,31 Wound complications with SRL in de novo kidney transplantation have occurred in up to 20-50% of patients, which is signifi cantly higher compared with other agents. [65][66][67] These include wound dehiscence, lymphocele formation, delayed wound healing, incisional hernias, and infections. Risk factors for wound complications include older age, obesity, diabetes, corticosteroid use, and cumulative mTOR-I dosages in the fi rst few days post transplant.…”

Section: Practical Considerations When Using Mtor-is: It's About Timementioning

confidence: 99%

“…Risk factors for wound complications include older age, obesity, diabetes, corticosteroid use, and cumulative mTOR-I dosages in the fi rst few days post transplant. [65][66][67] Strategies to reduce wound complications include avoidance of loading doses, minimization of steroids, and modifi cation of surgical techniques such as suction drain placement, use of nonabsorbable sutures when closing, and patient selection (e.g., avoidance in obese patients). 67,68 Early use of SRL in renal transplantation has been associated with delayed recovery from DGF, especially when loading dosages have been utitlized.…”

Section: Practical Considerations When Using Mtor-is: It's About Timementioning

confidence: 99%

The role of mTOR inhibition in renal transplant immune suppression

Patel

Dawson

Knight

et al. 2011

Dialysis & Transplantation

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The mammalian target of rapamycin inhibitors (mTOR‐Is) sirolimus and everolimus represent a class of proliferation signal inhibitors with a wide spectrum of activities, including suppression of T‐cell proliferation and reduction of tumor growth. In solid‐organ transplantation, mTOR inhibitors are an option for maintenance immune suppression due to their relative lack of nephrotoxicity compared with the current backbone of most regimens, the calcineurin inhibitors (CNIs). This property, in conjunction with their unique pharmacology, allows mTOR‐Is to be used as an adjunct or alternative to CNIs. Earlier studies of their use in de novo renal transplantation have delineated potential strategies for use of this class of drugs in groups of patients in whom mTOR inhibition may be useful. From recent kidney studies it appears that the time for introduction of mTOR‐I therapy may be prior to the development of proteinuria or signiﬁcant graft deterioration. Consideration should also be given to the use of mTOR‐Is in patients with or at high risk of post‐transplant malignancy. Due to potential toxicities, knowledge of the adverse effects and pharmacokinetic proﬁles of mTOR‐Is is necessary for proper management of patients receiving these agents.

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“…Sirolimus, an mTOR inhibitor, has a well-known association with wound complications. 2,3,[13][14][15][16][17] Mycophenolate mofetil (MMF) may hinder wound healing; however, it is difficult to assess the independent effect of MMF as it is rarely given as a single immunosuppressant agent. 18 Steroids may influence the rate of wound healing, which may increase the incidence of wound complications.…”

Section: Introductionmentioning

confidence: 99%

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Parsikia

Chang

et al. 2014

Exp Clin Transplant

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Objectives: This paper sought to determine if there were an association between drain placement and the incidence of wound complications. Materials and Methods: A single-center institutional review board-approved retrospective study between 2001 to 2008, comparing 680 kidney transplant patients who either had a drain placed or were left undrained. Linear regression modeling was used to adjust the risk factors between the groups. Patients received calcineurin inhibitors, steroids, and a mycophenolate formulation. The incidence of early major and minor wound complications were captured. Minor wound complications were defined as seroma, lymphocele, and perigraft fluid collection, and major wound complications were defined as wound dehiscence, hematomas, evisceration, infections, wound necrosis, and hernias. Patients with incomplete data or those taking sirolimus were excluded. Results: Six hundred eighty kidney transplant cases were reviewed. Four hundred seventy-nine received drains; 201 did not. Demographic analyses revealed that the drain group had a higher average value in age and body mass index. The drain group had a lower albumin and a lower mean platelet count after surgery. The number of patients without diabetes in the drain group numbered nearly twice as many as did those without drains. An attempt was made to statistically account for demographic differences.Seventy-eight of 479 drained patients (16.28%) and 24 of 201 no-drain patients (11.94%) had a wound complication. Minor wound complications were observed in 9 patients (1.88%) in the drain group and 6 in no-drain group (2.99%) (P = .3702). Major wound complications were observed in 58 patients in the drain group (12.18%) and 17 in the no-drain group (8.46%) (P = .1655). Drain placement had no effect on major or minor wound complications. Conclusions: Drain placement is not associated with major or minor wound complications in kidney transplants.

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Risk Factors for Wound Healing Complications in Sirolimus-Treated Renal Transplant Recipients

Cited by 45 publications

References 13 publications

UP-03.034 Is There a Relation Between Post Kidney Transplantation Antithymocyte Globulin Therapy and Wound Healing Disturbance?

UP-03.034 Is There a Relation Between Post Kidney Transplantation Antithymocyte Globulin Therapy and Wound Healing Disturbance?

The role of mTOR inhibition in renal transplant immune suppression

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