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No major neurologic complications with sirolimus use in heart transplant recipients
Diederik van de Beek1, Walter K Kremers, Sudhir S Kushwaha
1Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Sirolimus therapy in heart transplant recipients was not associated with major neurotoxicity, including stroke. While tremor and depression were noted, cerebrovascular events were absent in this patient group.
Area of Science:
- Cardiology
- Neurology
- Immunosuppression
Background:
- Heart transplantation is a life-saving procedure.
- Immunosuppressive therapy is crucial post-transplant.
- Sirolimus is an immunosuppressant with potential side effects.
Purpose of the Study:
- To investigate the association between sirolimus therapy and neurologic complications.
- To assess the risk of stroke and other neurotoxic events in heart transplant recipients on sirolimus.
Main Methods:
- Retrospective study of heart transplant recipients at Mayo Clinic.
- Analysis of 313 patients from January 1988 to June 2006.
- Comparison of outcomes in patients switched to sirolimus from cyclosporine-based therapy.
Main Results:
- Sirolimus use was not linked to major neurotoxicity or posterior reversible encephalopathy syndrome.
- Cerebrovascular events occurred in 14% of patients but none received sirolimus.
- Hazard ratio for neurologic/psychiatric events with sirolimus was 1.94, driven by tremor and depression.
Conclusions:
- Sirolimus immunosuppression did not result in early or late major neurotoxicity in heart transplant recipients.
- The absence of stroke and transient ischemic attacks in sirolimus-treated patients warrants further investigation.
Objective:
To determine whether sirolimus therapy is associated with neurologic complications, including stroke, among heart transplant recipients.
Patients And Methods:
We retrospectively studied patients who underwent heart transplant at Mayo Clinic's site in Rochester, MN, from January 1, 1988, through June 30, 2006.
Results:
Of 313 patients in the cohort, the medical regimen in 116 patients (37%) was switched from cyclosporine-based therapy to sirolimus. The hazard ratio of sirolimus for any neurologic or psychiatric event was 1.94 (95% confidence interval, 0.67-4.29). This hazard ratio was driven mainly by the association between sirolimus and the development of tremor and depression. Cerebrovascular events occurred with a cumulative incidence of 14% but did not occur in any of the patients who received sirolimus therapy. There were no cases of posterior reversible encephalopathy syndrome with sirolimus use.
Conclusion:
No early or late episodes of major neurotoxicity occurred in heart transplant recipients using sirolimus immunosuppression. The absence of stroke and transient ischemic attacks in these high-risk transplant recipients treated with sirolimus is notable but needs confirmation in future studies.
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