Adverse Effects of Mammalian Target of Rapamycin Inhibitors During the Postoperative Period After Cardiac Transplantation

• Published in: Transplantation proceedings Vol. 40; no. 9; pp. 3027 - 3030
• Main Authors: Bouzas-Mosquera, A, Crespo-Leiro, M.G, Paniagua, M.J, Naya, C, Grille, Z, Marzoa, R, Barge-Caballero, E, Estévez-Cid, F, Álvarez-García, N, Cuenca, J.J, Castro-Beiras, A
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.11.2008; Elsevier
• Subjects: Adult; Biological and medical sciences; Diabetes Mellitus - epidemiology; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Heart Transplantation - adverse effects; Heart Transplantation - immunology; Humans; Immunosuppressive Agents - therapeutic use; Male; Medical sciences; Middle Aged; Patient Selection; Pericardial Effusion - epidemiology; Pleural Effusion - epidemiology; Postoperative Period; Protein Kinases - therapeutic use; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; TOR Serine-Threonine Kinases; Heart; Postoperative; Toxicity; Period; Transplantation; Homotransplantation; Medicine; Treatment; Surgery; Mammalian target of rapamycin; Secondary effect; Graft; Inhibitor; Circulatory system
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.09.021

Abstract Introduction Safety of treatment with mammalian target of rapamycin inhibitors (mTORi) in the postoperative period after heart transplantation (HT) is controversial. Methods We evaluated the incidence of postoperative complications (pericardial, pleural, and surgical wound complications) among nine de novo heart transplant recipients treated with mTORi compared with 19 patients who did not receive them during the same period (control group). Results No significant differences were observed between the two groups regarding sex, age, body mass index, pretransplant diagnosis, history of diabetes mellitus, prior cardiac surgery, or baseline renal function. The main laboratory parameters at 1 month were also similar. During the first 2 months after HT, four patients (44%) in the mTORi group developed severe pericardial effusions requiring drainage, compared to 1 (5%) in the control group ( P = .026). All patients presenting this complication in the mTORi group received everolimus. In addition, two cases of sternal dehiscence were observed in the mTORi group, compared to none in the control group ( P = .09); one patient on everolimus required sternal reopening and debridement for clinically suspected mediastinitis. Duration of chest tube drainage, quantity of collected pleural fluid, and need for thoracentesis were similar in both groups. Conclusions In our series, patients receiving mTORi—particularly everolimus—during the postoperative period after HT showed a higher incidence of severe pericardial effusion requiring drainage, as well as a trend toward a higher incidence of sternal dehiscence, as compared to a group not receiving mTORi. The use of mTORi during the early postcardiac transplant period should be individualized.