Sirolimus en trasplante cardíaco

Resumo

Introduction: Sirolimus is an immunosuppressant with an action mechanism and a safety profile different from traditional immunosuppressants. Currently, it is only authorized in Spain for the prophylaxis of organ rejection in renal transplantation. Its use in other types of transplants has to be requested under the «compassionate use» mode. Objective: Evaluation of adverse reactions to sirolimus in patients with heart transplantation during the first six months of treatment. Method: Retrospective revision of clinical records, evaluating: drug indication, posologic regimens, evolution and adverse-effect profile with respect to those described in patients with renal transplantation. Results: Thirteen requests for sirolimus under compassionate use have been made (100% of the total processed ones). The indications were: immunosuppression in five patients with graft vascular disease and immunosuppression due to the adverse effect of the calcineurin inhibitor (four patients due to renal failure, three with neoplasia and one with neuropathic pain). The average dose was of 2-3 mg/day (non-fractionable tablets) with an interval of 1-5 mg. The adverse-effect profile was similar to that described in patients with renal transplantation, while higher rates of hypertriglyceridemia and lower lycopenia, thrombocytopenia, urinary infection and edema levels were experienced. Conclusion: Sirolimus seems to have an important role in immunosuppression for those patients that present adverse effects due to calcineurin inhibitors, with an adverse-effect profile similar to that described in patients with renal transplantation