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Updated: May 3, 2026
Murine Full-thickness Skin Transplantation
Published on: January 2, 2017
Impaired lower extremity wound healing secondary to sirolimus after kidney transplantation
J George Devries1, Rachel C Collier2, Jeffrey A Niezgoda3
1A PGY-2 Resident; Wheaton Fransciscan Healthcare, Milwaukee, WI.
Purpose:
Sirolimus is an immunosuppressive drug used as part of the drug regimen after kidney, liver, and heart transplantation. There have been numerous reports of transplant surgical wound healing complications secondary to sirolimus. The authors present a case of impaired wound healing in the lower extremity after kidney transplantation for a patient on sirolimus. This is one of the few reported cases that we are aware of that demonstrates the effects of sirolimus on wound healing at a nontransplant site.
Methods:
A case highlighting aggressive limb-salvage modalities for a kidney transplant patient on sirolimus is presented. The subject was informed that data concerning the case would be submitted for publication. A brief review of the literature shows the wound healing problems previously associated with sirolimus.
Results:
Despite all salvage techniques employed, including aggressive early debridement, forefoot offloading, IV antibiotics, negative pressure wound therapy, and hyperbaric oxygen therapy, the patient eventually went on to failure and a transtibial amputation.
Conclusion:
Physicians specializing in wound care and limb salvage must be aware of the effects of sirolimus on wound healing and should consider modifications to these patients' immunosuppressive regimens.
Insights
Sirolimus, an immunosuppressant, can impair wound healing, even at non-transplant sites. Aggressive treatments failed in a kidney transplant patient, necessitating amputation, highlighting the drug's risks.
Area of Science:
- Transplantation immunology
- Wound healing research
Background:
- Sirolimus is a key immunosuppressant in organ transplantation.
- Impaired wound healing is a known complication of sirolimus therapy.
Purpose of the Study:
- To present a case of severe lower extremity wound healing impairment in a kidney transplant patient on sirolimus.
- To highlight sirolimus's impact on wound healing at a non-transplant site.
Main Methods:
- Case report of a kidney transplant recipient on sirolimus with lower extremity wound complications.
- Review of literature on sirolimus-associated wound healing issues.
- Application of aggressive limb-salvage techniques.
Main Results:
- Despite extensive interventions including debridement, offloading, antibiotics, negative pressure wound therapy, and hyperbaric oxygen, the wound failed to heal.
- The patient ultimately required a transtibial amputation.
Conclusions:
- Sirolimus can significantly impede wound healing, even in non-transplant surgical sites.
- Wound care and limb salvage specialists should consider sirolimus's impact on healing.
- Modification of immunosuppressive regimens may be necessary for patients with wound complications.
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