Rogers C C, Hanaway M, Alloway R R, Alexander J W, Boardman R E, Trofe J, Gupta M, Merchen T, Buell J F, Cardi M, Roy-Chaudhury P, Succop P, Woodle E S
Department of Surgery, Division of Transplantation, University of Cincinnati, Cincinnati, Ohio 45267-0558, USA.
Transplant Proc. 2005 Mar;37(2):795-7. doi: 10.1016/j.transproceed.2004.12.076.
Sirolimus (RAPA) and corticosteroids (CS) both inhibit wound healing. To evaluate the possibility that RAPA and CS have additive effects on wound healing, we evaluated the effects of corticosteroid avoidance (CSAV) on wound healing complications in patients treated with RAPA.
One hundred nine patients treated with a CSAV regimen (no pretransplantation or posttransplantation CS) were compared with a historical control group (n = 72) that received cyclosporine (CsA), mycophenolate mofetil (MMF), and CS. The CSAV group received low-dose CsA, MMF, RAPA, and thymoglobulin induction. Complications were classified as follows: wound healing complications (WHC) or infectious wound complications (IWC). WHC included lymphocele, hernia, dehiscence, diastasis, and skin edge separation. IWC included wound abscess and empiric antibiotic therapy for wound erythema.
The CSAV group was largely CS-free: 11% of patients received CS for rejection, 12% of patients received CS for recurrent disease, and 85% of patients are currently off CS. The CSAV group had a significantly lower incidence of WHC (13.7% vs 28%; P = .03) and lymphoceles (5.5% vs 16%; P = .02) than the control group. There was no difference in the incidence of IWC between the 2 groups. Patients who received CSAV were 18% less likely (P = .57) to develop any type of complication, 41% less likely (P = .20) to develop a WHC, and 71% less likely (P = .018) to develop a lymphocele.
CSAV in a RAPA-based regimen results in a marked reduction in WHC and lymphoceles. Therefore, CSAV provides a promising approach for addressing WHC associated with RAPA therapy.
西罗莫司（RAPA）和皮质类固醇（CS）均会抑制伤口愈合。为评估RAPA和CS对伤口愈合是否具有叠加效应，我们评估了避免使用皮质类固醇（CSAV）对接受RAPA治疗患者伤口愈合并发症的影响。
将109例采用CSAV方案（移植前或移植后均未使用CS）治疗的患者与一个历史对照组（n = 72）进行比较，该对照组接受环孢素（CsA）、霉酚酸酯（MMF）和CS治疗。CSAV组接受低剂量CsA、MMF、RAPA和抗胸腺细胞球蛋白诱导治疗。并发症分类如下：伤口愈合并发症（WHC）或感染性伤口并发症（IWC）。WHC包括淋巴囊肿、疝、裂开、分离和皮肤边缘分离。IWC包括伤口脓肿以及针对伤口红斑的经验性抗生素治疗。
CSAV组基本未使用CS：11%的患者因排斥反应接受CS治疗，12%的患者因疾病复发接受CS治疗，85%的患者目前未使用CS。CSAV组的WHC发生率（13.7%对28%；P = .03）和淋巴囊肿发生率（5.5%对16%；P = .02）显著低于对照组。两组间IWC发生率无差异。接受CSAV治疗的患者发生任何类型并发症的可能性降低18%（P = .57），发生WHC的可能性降低41%（P = .20），发生淋巴囊肿的可能性降低71%（P = .018）。
基于RAPA的方案中采用CSAV可显著降低WHC和淋巴囊肿的发生率。因此，CSAV为解决与RAPA治疗相关的WHC提供了一种有前景的方法。
