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Steroid withdrawal five days after renal transplantation allows for the prevention of wound‐healing complications associated with sirolimus therapy
Author(s) -
Sandrini Silvio,
Setti Gisella,
Bossini Nicola,
Maffei Camilla,
Iovinella Lucia,
Tognazzi Nadia,
Maffeis Roberto,
Nodari Franco,
Portolani Nazario,
Cancarini Giovanni
Publication year - 2009
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2008.00890.x
Subject(s) - medicine , lymphocele , transplantation , surgery , sirolimus , incidence (geometry) , kidney transplantation , tacrolimus , wound healing , wound dehiscence , diabetes mellitus , prospective cohort study , urology , gastroenterology , endocrinology , physics , optics
Background: Sirolimus (SRL) can increase the risk of wound complications. In this study, we investigated the impact of steroids when added to SRL, in this side effect. Methods: One hundred and forty‐eight patients entered prospective studies comparing early (fifth day) with late (sixth month) steroid withdrawal. All patients were on SRL, added either to Tacrolimus (n = 56) or to cyclosporine (n = 97). At 15th day after transplantation, 68 patients were on steroids (On‐St group) and 80 were not (Off‐St group). Wound complications considered were as follows: dehiscence, lymphocele, wound leakage, hematoma and seromas. Risk factors under analysis were as follows: body mass index, diabetes, rejection, creatininemia, length of dialysis before transplantation, recipient age, being on steroids at 15th day, SRL levels. Results: The overall incidence of wound complications was significantly lower in Off‐St group than in On‐St group: 18.8% vs. 45.6%, respectively (p < 0.0004). In detail, lymphocele: 5.0% vs. 32.3% (p < 0.0001); dehiscence 0% vs. 10.3% (p < 0.009), leakage 6.2% vs. 8.8% (p = NS), seromas 1.4% vs. 7.5% (NS). At multivariate analysis, the addition of steroids to SRL increases 4.2‐fold the risk for wound complications. Conclusions: Early steroid withdrawal is effective in preventing both the incidence and the severity of wound‐healing complications because of SRL regime, even when started with a loading dose.