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Airway anastomotic dehiscence associated with use of sirolimus immediately after lung transplantation

King-Biggs, Melissa B.1; Dunitz, Jordan M.1; Park, Soon J.2; Kay Savik, S.3; Hertz, Marshall I.1 4

doi: 10.1097/01.TP.0000064083.02120.2C
Rapid Communications

Goal.  The goal of this study was to assess the efficacy of sirolimus in lung-transplant recipients.

Methods.  The study was designed as a single center, consecutive case study of lung-transplant recipients treated with sirolimus, tacrolimus, and prednisone. All study subjects also received an HMG-CoA reductase inhibitor, and prophylaxis for cytomegalovirus and Pneumocystis carinii.

Results.  A total of 15 subjects were enrolled in the study. Within 6 months, significant airway complications occurred in four subjects, three of whom died. At that point, the investigators terminated enrollment in the study. The study population was compared retrospectively with a group of 83 consecutive lung recipients treated with cyclosporine (n=64) or tacrolimus (n=19), mycophenolate mofetil, and prednisone. This confirmed an increased incidence of airway dehiscence and reduced survival in the sirolimus-treated patients. Sirolimus-treated patients had a low incidence of acute rejection. No significant differences were noted in the incidence of bacterial or fungal bronchopulmonary infections.

Conclusions.  We observed an unexpectedly high incidence of postoperative airway dehiscence in lung-transplant recipients treated with sirolimus, in combination with tacrolimus, prednisone, and an HMG-CoA inhibitor. Further studies will be needed to determine the safety and efficacy of using sirolimus after complete airway healing has occurred.

1 Division of Pulmonary, Allergy, and Critical Care Medicine, University of Minnesota Medical School, Minneapolis, MN.

2 Division of Cardiovascular and Thoracic Surgery, University of Minnesota Medical School, Minneapolis, MN.

3 School of Nursing, University of Minnesota, Minneapolis, MN.

4 Address correspondence to: Dr. Marshall I. Hertz, Mayo Mail Code 276, 420 Delaware Street SE, Minneapolis, MN 55455. E-mail: hertz001@umn.edu.

This work was supported by Wyeth-Ayerst Pharmaceuticals.

Received 11 October 2002.

Accepted 12 December 2002.

© 2003 Lippincott Williams & Wilkins, Inc.