The role of sirolimus in liver transplantation

Abstract

Purpose of review Side effects of immunosuppressants contribute to long-term morbidity and impact quality of life following liver transplantation. In this article, recent publications on the potential role and side effects of sirolimus in liver transplant recipients will be reviewed. Recent findings Early reports of hepatic artery thrombosis associated with sirolimus led to the cessation of a multicenter trial and a ‘black box’ warning by the Food and Drug Administration. Interest in the agent remained, however, as several single center studies reported improvement in renal function and decreased neurotoxicities with sirolimus-based immunosuppression. Attention has been drawn to its antineoplastic characteristics for patients with hepatocellular carcinoma and the antiproliferative properties for patients with hepatitis C virus infection. In addition to the well known side effects, there have been recent reports of proteinuria and pulmonary complications associated with sirolimus. Summary Sirolimus appears to be a safe alternative to calcineurin inhibitors when used after the immediate postoperative period, benefiting patients with calcineurin inhibitor-induced toxicities. Larger randomized control trials comparing calcineurin inhibitor with sirolimus-based regimens are needed to determine which is best for specific patient populations.