Sirolimus-Induced Severe Hypertriglyceridemia in a Lung Transplant Recipient

Severe Hypertriglyceridemia Induced by Sirolimus Treated With Medical Management Without Plasmapheresis: A Case Report

“…The sirolimus level upon admission in the first case by Femandez-Bussy et al was 11 mg/dL and was 2.2 mg/dL in our case. 5 Firpi et al reported 6 cases of sirolimus-induced hypertriglyceridemia in liver transplant recipients also receiving tacrolimus or cyclosporine. 2 It showed that all of patients had therapeutic sirolimus mean trough levels <15 mg/dL but developed significant hypertriglyceridemia.…”

Major involvement of mTOR in the PPARγ-induced stimulation of adipose tissue lipid uptake and fat accretion

“…In the present study, we elucidated the as yet unknown mechanism underlying the hypertriglyceridemia associated with mTOR inhibition. Such dyslipidemia is one of the major side effects adversely affecting transplanted and cancer patients under rapamycin therapy and one of the most prevalent reasons for treatment discontinuation (29)(30)(31)(32)(33)(34). Plasma TAG levels represent the balance between gut and liver TAG-rich lipoprotein secretion and LPL-mediated clearance in extrahepatic tissues, adipose depots being responsible for a large fraction of total body lipid clearance in the postprandial state.…”

Unexplained hemolysis in patients undergoing ECMO: beware of hypertriglyceridemia

“…Plasmapheresis is effective in rapidly reducing triglyceride levels and has been used in similar cases of sirolimus-induced hypertriglyceridemia in lung transplant patients. 6 In the second case, hypertriglyceridemia was induced by propofol, even though our patient did not meet the criteria for PRIS. PRIS is defined as the development of metabolic acidosis and cardiac dysfunction plus rhabdomyolysis, hypertriglyceridemia or renal failure after the initiation of propofol therapy.…”