Abstract
TO THE EDITOR: In a recent case report, Guilbeau presented 3 cases of sirolimus-treated liver transplant patients with delayed surgical wound healing and dehiscence that responded to switching to alternative therapy. 1 It should be noted that delayed wound healing is also likely to occur in kidney transplantation and other transplant procedures involving abdominal surgery. 2 In kidney transplantation, sirolimus is a well-established agent, 3 and lack of published reports on this issue, despite relatively widespread use, suggests this is not a use-limiting toxicity.
It is difficult to determine the incidence of dehiscence in liver recipients at the author's center from the case report, 1 but the article identifies an important clinical consideration in determining the appropriate use of sirolimus in liver transplantation, at a time when published multicentered trial data are still lacking. Other reasons to avoid prescribing sirolimus early after liver transplantation were also recently elucidated. A prominent warning in the package insert now highlights an increased risk of mortality and graft loss when sirolimus is used with tacrolimus in de novo liver transplant recipients. 4 An increased incidence of hepatic artery thrombosis leading to graft loss or death, generally occurring within 30 days after surgery, has also been noted when sirolimus is used with either tacrolimus or cyclosporine in de novo liver transplantation. These findings should be strongly considered by clinicians before administration of sirolimus to additional liver transplant recipients.
Comments on articles previously published are submitted to the authors of those articles. When no reply is published, either the author chose not to respond or did not do so in a timely fashion. Comments and replies are not peer reviewed.–ED.