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| Probable sirolimus-induced rupture of arterial anastomosis after liver transplantation in a patient intolerant of tacrolimus |
| Meng-Yi Lao a , b , Tao Ma a , b , Xue-Li Bai a , b , Xiao-Zhen Zhang a , b , Tian-Yu Tang a , b , Ting-Bo Liang a , b , ∗ |
a Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou
310003, China
b Key Laboratory of Pancreatic Disease of Zhejiang Province, Hangzhou 310009, China
∗ Corresponding author at: Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, China.
E-mail address: liangtingbo@zju.edu.cn (T.-B. Liang). |
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Abstract Liver transplantation remains the only cure for end-stage liver disease. Tacrolimus is widely used as a first-line immunosuppressive drug to prevent organ rejection after liver transplantation [1–3] . However, tacrolimus has a narrow therapeutic index and wide inter-individual variability in pharmacokinetics, which can result in underimmunosuppression or toxicity. Orally administered tacrolimus is rapidly absorbed from the distal gastrointestinal tract and extensively metabolized in the liver and intestinal walls by cytochrome P450 (CYP) 3A4 and 3A5 [2,4,5] . The activity of these enzymes has significant influence on the pharmacokinetics of tacrolimus. CYP3A5 polymorphism roots the individual differences in tacrolimus bioavailability [1] . Due to the drug’s narrow therapeutic range, dosage adjustments to achieve the desired blood concentration are challenging. Serum concentrations above the therapeutic range may result in nephrotoxicity and neurotoxicity [5] . An alternative to tacrolimus is sirolimus, a newly developed immunosuppressive agent for use in organ transplant recipients [6,7] . However, sirolimus is known to impair wound healing, which limits its early clinical application [8,9] . We report a case of probable sirolimus-induced rupture of arterial anastomoses after liver transplantation in a patient intolerant of tacrolimus.
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2019, Vol. 18 
