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Postoperative complications associated with perioperative sirolimus prior to pediatric cardiac retransplantation
Jason F Goldberg1, Aamir Jeewa1, William J Dreyer1
1Baylor College of Medicine, Houston, Texas.
Insights
Sirolimus use before repeat pediatric heart transplants increased pleural effusions but did not affect mortality or other complications. Further research is needed to manage these postoperative issues.
Area of Science:
- Pediatric Cardiology
- Immunosuppression Therapy
- Transplantation Medicine
Background:
- Sirolimus is used in pediatric cardiac transplantation for various complications.
- Concerns exist regarding sirolimus's impact on wound healing and postoperative issues.
- Limited pediatric data exists on perioperative sirolimus use, especially after repeat transplants.
Purpose of the Study:
- To evaluate the perioperative effects of sirolimus in children undergoing repeat cardiac transplantation.
- To compare postoperative complications in patients who received sirolimus before repeat transplantation versus those who did not.
Main Methods:
- Retrospective comparison of pediatric patients receiving sirolimus before repeat cardiac transplantation.
- Comparison group included patients from the same era not receiving sirolimus.
- Outcomes assessed included pleural effusions, mortality, renal dysfunction, infection, rejection, and length of stay.
Main Results:
- 100% of patients on sirolimus developed pleural effusions compared to 17% in the control group (p=0.013).
- No significant differences were observed in mortality, renal dysfunction, serious bacterial infection, rejection, or postoperative length of stay.
- The study involved a small cohort of 5 patients in the sirolimus group.
Conclusions:
- Sirolimus use was associated with a statistically significant increase in pleural effusions in this small patient cohort.
- Further investigation is required to establish strategies for mitigating postoperative complications in pediatric patients on sirolimus.
- The findings highlight a specific risk associated with sirolimus in the perioperative period of repeat cardiac transplantation.
Objectives:
Sirolimus has been used in pediatric cardiac transplantation for the past decade for chronic renal dysfunction, recurrent rejection, and/or coronary allograft vasculopathy. There has been concern regarding the effect of sirolimus on wound healing and other postoperative complications. To date, the pediatric literature on its use is limited and has not specifically addressed its use in the perioperative period following repeat cardiac transplantation.
Methods:
We compared the patients in our institution who received sirolimus before repeat cardiac transplantation to those in the same era who did not receive sirolimus.
Results:
Of the 5 patients in the study group, 5 (100%) developed pleural effusions vs 1 (17%) in the control group (p=0.013). There was no increase in mortality in the sirolimus group, and there were no significant differences in renal dysfunction, serious bacterial infection, rejection, or postoperative length of stay.
Conclusions:
In this small data set, there was a statistically significant increase in pleural effusions in patients on sirolimus. Further study is needed to develop an appropriate strategy to avoid postoperative complications in this patient population.
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