Sirolimus does not increase the risk for postoperative thromboembolic events among renal transplant recipients1

Langer, Róbert; Kahan, Barry D.

doi:10.1097/01.tp.0000071203.62964.da

Cited by 30 publications

(11 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In April 2002, the FDA issued a black box warning regarding an increased risk of hepatic artery thrombosis with de novo use of sirolimus in liver transplant recipients (31,32). In contrast, other studies in both the liver and renal transplant literature have not found an association between sirolimus use and VTE (38)(39)(40)(41)(42)(43)(44)(45).…”

Section: Discussionmentioning

confidence: 65%

Sirolimus use and incidence of venous thromboembolism in cardiac transplant recipients

Thibodeau

Mishkin

Patel

et al. 2012

Clinical Transplantation

View full text Add to dashboard Cite

Sirolimus is an immunosuppressive agent increasingly used in cardiac transplant recipients in the setting of allograft vasculopathy or worsening renal function. Recently, sirolimus has been associated with increased risk of venous thromboembolism (VTE) in lung transplant recipients. To investigate whether this association is also present in cardiac transplant recipients, we retrospectively reviewed the charts of 67 cardiac transplant recipients whose immunosuppressive regimen included sirolimus and 134 matched cardiac transplant recipients whose regimen did not include sirolimus. Rates of VTE were compared. Multivariable Cox proportional hazards models tested the association of sirolimus use with VTE. A higher incidence of VTE was seen in patients treated with vs. without sirolimus (8/67 [12%] vs. 9/134 [7%], log-rank statistic: 4.66, p=0.03). Lower body mass index (BMI) and total cholesterol levels were also associated with VTE (p<0.05). The association of sirolimus with VTE persisted when adjusting for BMI (hazard ratio [95% confidence interval]: 2.96 [1.13, 7.75], p=0.03) but not when adjusting for total cholesterol (p=0.08). These data suggest that sirolimus is associated with an increased risk of VTE in cardiac transplant recipients, a risk possibly mediated through comorbid conditions. Larger, more conclusive studies are needed. Until such studies are completed, a heightened level of awareness for VTE in cardiac transplant recipients treated with sirolimus appears warranted.

show abstract

Section: Discussionmentioning

confidence: 65%

Sirolimus use and incidence of venous thromboembolism in cardiac transplant recipients

Thibodeau

Mishkin

Patel

et al. 2012

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…30 -32 In a study of renal transplant recipients, SIR administration, as part of an immunosuppressive regimen that included cyclosporine (CsA) and PRED, was not associated with an in- creased risk of post-operative thromboembolic events. 33 However, as the investigators pointed out, there were major limitations to their retrospective analyses of a non-randomized, non-contemporaneous patient population receiving different dosing regimens. It is also possible that, even if their conclusion was confirmed in a more rigorous study, findings in renal transplant patients may not necessarily be true for lung transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

Increased risk of venous thromboembolism with a sirolimus-based immunosuppression regimen in lung transplantation

Ahya

McShane

Baz

et al. 2011

The Journal of Heart and Lung Transplantation

View full text Add to dashboard Cite

“…In a retrospective analysis of 354 patients treated with SRL and 136 matched controls, SRL was not associated with an increased risk of deep vein thrombosis (DVT), but the DVT that did develop were preceded by lymphocoele in three‐quarters of cases 67 …”

Section: Adverse Effects Of Sirolimusmentioning

confidence: 99%

Sirolimus: Its role in nephrology (Review Article)

Lee

Chapman

2005

Nephrology

View full text Add to dashboard Cite

SUMMARY:Sirolimus (Rapamycin, Wyeth Pharmaceuticals Australia Pty Ltd, Baulkham Hills, NSW, Australia) (SRL) has received increasing attention as an immunosuppressant in renal and other solid organ transplantation. Sirolimus is the first marketed agent in a new class of drugs with a novel mechanism of action. Sirolimus binds, like tacrolimus, to a member of the FK binding protein (FKBP) family. The SRL/FKBP complex binds to the protein kinase mTOR. Binding to mTOR blocks activation of signal transduction pathways causing arrest of the cell cycle in the G1 phase. It is now known that mTOR is a central regulator of cell growth and proliferation. The immunosuppressive properties of SRL are due primarily to blockade of interleukin-2 (IL-2)-induced proliferation of T cells. There is still much to be learnt about how best to use the drug. The key advantage over the current choice of immunosuppressive agents is the ability to preserve renal function and pathology while producing excellent rejection-free, graft survival rates. Thus, SRL may find its pivotal role as a calcineurin inhibitors replacement in patients whose grafts are affected by chronic allograft nephropathy. A second major driver for use may prove to be the impact of SRL on cancer incidence and prognosis. Studies still need to be performed to evaluate the best timing for commencement of SRL and the optimal dosage to minimize side-effects.

show abstract

Sirolimus does not increase the risk for postoperative thromboembolic events among renal transplant recipients1

Abstract: Addition of sirolimus to a CsA+Pred regimen does not increase the incidence of postoperative thrombotic events among renal transplant recipients.

Cited by 30 publications

References 24 publications

Sirolimus use and incidence of venous thromboembolism in cardiac transplant recipients

Sirolimus use and incidence of venous thromboembolism in cardiac transplant recipients

Increased risk of venous thromboembolism with a sirolimus-based immunosuppression regimen in lung transplantation

Sirolimus: Its role in nephrology (Review Article)

Contact Info

Product

Resources

About