Wound healing complications and the use of mammalian target of rapamycin inhibitors in kidney transplantation: a critical review of the literature.

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, Björn

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 - Humans

KW - Risk Factors

KW - Treatment Outcome

KW - Risk Assessment

KW - Drug Therapy, Combination

KW - Immunosuppressive Agents/adverse effects

KW - Kidney Transplantation/adverse effects

KW - Postoperative Complications/chemically induced/pathology

KW - Protein Kinase Inhibitors/adverse effects

KW - Sirolimus/adverse effects/analogs & derivatives

KW - TOR Serine-Threonine Kinases/antagonists & inhibitors/metabolism

KW - Wound Healing/drug effects

KW - Humans

KW - Risk Factors

KW - Treatment Outcome

KW - Risk Assessment

KW - Drug Therapy, Combination

KW - Immunosuppressive Agents/adverse effects

KW - Kidney Transplantation/adverse effects

KW - Postoperative Complications/chemically induced/pathology

KW - Protein Kinase Inhibitors/adverse effects

KW - Sirolimus/adverse effects/analogs & derivatives

KW - TOR Serine-Threonine Kinases/antagonists & inhibitors/metabolism

KW - Wound Healing/drug effects

M3 - SCORING: Journal article

VL - 94

SP - 547

EP - 561

JO - TRANSPLANTATION

JF - TRANSPLANTATION

SN - 0041-1337

IS - 6

M1 - 6

ER -