Kuppahally S, Al-Khaldi A, Weisshaar D, Valantine H A, Oyer P, Robbins R C, Hunt S A
Department of Cardiac Transplant, Stanford University Medical Center & Northern California Kaiser Permanente Heart Transplant Program, Stanford, CA, USA.
Am J Transplant. 2006 May;6(5 Pt 1):986-92. doi: 10.1111/j.1600-6143.2006.01282.x.
Sirolimus was introduced in de novo immunosuppression at Stanford University in view of its favorable effects on reduced rejection and cardiac allograft vasculopathy. After an apparent increase in the incidence of post-surgical wound complications as well as symptomatic pleural and pericardial effusions, we reverted to a mycophenolate mofetil (MMF)-based regimen. This retrospective study compared the outcome in heart transplant recipients on sirolimus (48 patients) with those on MMF (46 patients) in de novo immunosuppressive regimen. The incidence of any post-surgical wound complication (52% vs. 28%, p=0.019) and deep surgical wound complication (35% vs. 13%, p=0.012) was significantly higher in patients on sirolimus than on MMF. More patients on sirolimus also had symptomatic pleural (p=0.035) and large pericardial effusions (p=0.033) requiring intervention. Logistic regression analysis showed sirolimus (p=0.027) and longer cardiac bypass time (OR=1.011; p=0.048) as risk factors for any wound complication. Sirolimus in de novo immunosuppression after cardiac transplantation was associated with a significant increase in the incidence of post-surgical wound healing complications as well as symptomatic pleural and pericardial effusions.
鉴于西罗莫司对降低排斥反应和心脏移植血管病变有良好效果，斯坦福大学将其用于初始免疫抑制治疗。在术后伤口并发症以及有症状的胸腔和心包积液的发生率明显增加后，我们恢复使用基于霉酚酸酯（MMF）的治疗方案。这项回顾性研究比较了接受初始免疫抑制治疗的心脏移植受者中，使用西罗莫司的患者（48例）和使用MMF的患者（46例）的结局。使用西罗莫司的患者术后任何伤口并发症的发生率（52%对28%，p=0.019）和深部手术伤口并发症的发生率（35%对13%，p=0.012）显著高于使用MMF的患者。更多使用西罗莫司的患者也有需要干预的有症状胸腔积液（p=0.035）和大量心包积液（p=0.033）。逻辑回归分析显示西罗莫司（p=0.027）和较长的体外循环时间（OR=1.011；p=0.048）是任何伤口并发症的危险因素。心脏移植后初始免疫抑制治疗中使用西罗莫司与术后伤口愈合并发症以及有症状的胸腔和心包积液的发生率显著增加相关。
