TY - JOUR
T1 - Wound healing complications and the use of mammalian target of rapamycin inhibitors in kidney transplantation: a critical review of the literature
AU - Nashan, B
AU - Citterio, Franco
PY - 2012
Y1 - 2012
N2 - Surgical complications, including events such as lymphocele and urological complications that affect wound healing, are reported with an incidence of 15% to 32% after kidney transplantation. The experience of the surgeon and comorbidities play an important role in determining the risk of such complications occurring. Since the introduction of the inosine 5'-monophosphate dehydrogenase inhibitors (mycophenolate mofetil) to the immunosuppressive armamentarium, replacing the antimetabolite prodrug azathioprine, reports have associated certain forms of wound healing complications (wound dehiscence, impaired healing, lymphocele, and incisional hernia) with the use of these agents. When mammalian target of rapamycin (mTOR) inhibitors (sirolimus, everolimus) became available, these findings were observed increasingly, particularly in direct comparisons with inosine 5'-monophosphate dehydrogenase inhibitors. The purpose of this article was to review the reported incidence of wound healing complications from randomized clinical trials that investigated the use of sirolimus- and everolimus-based treatment regimens in de novo kidney transplantation and the information available from the U.S. Food and Drug Administration database. The clinical trials included were primarily identified using biomedical literature database searches, with additional studies added at the authors' discretion. This review summarizes these studies to consider whether modern mTOR inhibitor-based immunosuppressive regimens exert and affect wound healing after kidney transplantation.
AB - Surgical complications, including events such as lymphocele and urological complications that affect wound healing, are reported with an incidence of 15% to 32% after kidney transplantation. The experience of the surgeon and comorbidities play an important role in determining the risk of such complications occurring. Since the introduction of the inosine 5'-monophosphate dehydrogenase inhibitors (mycophenolate mofetil) to the immunosuppressive armamentarium, replacing the antimetabolite prodrug azathioprine, reports have associated certain forms of wound healing complications (wound dehiscence, impaired healing, lymphocele, and incisional hernia) with the use of these agents. When mammalian target of rapamycin (mTOR) inhibitors (sirolimus, everolimus) became available, these findings were observed increasingly, particularly in direct comparisons with inosine 5'-monophosphate dehydrogenase inhibitors. The purpose of this article was to review the reported incidence of wound healing complications from randomized clinical trials that investigated the use of sirolimus- and everolimus-based treatment regimens in de novo kidney transplantation and the information available from the U.S. Food and Drug Administration database. The clinical trials included were primarily identified using biomedical literature database searches, with additional studies added at the authors' discretion. This review summarizes these studies to consider whether modern mTOR inhibitor-based immunosuppressive regimens exert and affect wound healing after kidney transplantation.
KW - Combination
KW - Drug Therapy
KW - Humans
KW - Immunosuppressive Agents
KW - Kidney Transplantation
KW - Postoperative Complications
KW - Protein Kinase Inhibitors
KW - Risk Assessment
KW - Risk Factors
KW - Sirolimus
KW - TOR Serine-Threonine Kinases
KW - Treatment Outcome
KW - Wound Healing
KW - Combination
KW - Drug Therapy
KW - Humans
KW - Immunosuppressive Agents
KW - Kidney Transplantation
KW - Postoperative Complications
KW - Protein Kinase Inhibitors
KW - Risk Assessment
KW - Risk Factors
KW - Sirolimus
KW - TOR Serine-Threonine Kinases
KW - Treatment Outcome
KW - Wound Healing
UR - https://publicatt.unicatt.it/handle/10807/51837
UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=84866731714&origin=inward
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84866731714&origin=inward
U2 - 10.1097/TP.0b013e3182551021
DO - 10.1097/TP.0b013e3182551021
M3 - Article
SN - 0041-1337
VL - 94
SP - 547
EP - 561
JO - Transplantation
JF - Transplantation
IS - 6
ER -