Background:

Safety of everolimus(EVR)when used at an early stage after living donor liver transplantation (LDLT) was proven by many centers including ours. However, the opponents of this drug argue for possible increased rates of wound infections after transplant surgery.The safety of use of mTOR inhibitors,mainly EVR,in patients undergoing major surgeries in post-transplant period for non-transplant related causes has not been elucidated and the factual data related to EVR role in wound infection remains scarce.In this retrospective analysis, we determined the possible impact of EVR when used as primary immunosuppressant on the wound infection and/or wound dehiscence.

Materials and methods:

From August 2002 to January 2016, 695 LDLT surgeries were performed at China Medical University Hospital, Taiwan.EVR has been used in 325 liver transplant recipients since February 2012 till January 2016.A total of 54 liver transplant recipients underwent non-transplant surgeries in post-operative period ranging from 2^nd post-transplant month to 4 years post-transplantation.

Results:

54 liver transplant recipients (Male:Female, 41:13) received non-transplant surgeries as early as 2^nd postoperative month till 4 year post-transplantation.The mean age of the study cohort was 55 + 8 (range, 27 to 72 years). Eleven patients (n=11) underwent minor surgical procedures and 43 patients underwent major surgeries that included major laparotomies, thoracic, orthopaedic and neurosurgeries. The EVR dose was 1 ± 0.50 mg/day against an average EVR trough level of 3.57 ± 1.24 ng/ml (Range, <1.5-6.3) at the time of non-transplant surgical procedures. The average trough level of tacrolimus in these patients at 3 months,12 months post-transplant period was 8.03 ± 3.85 ng/ml and 6 ± 2.37 ng/ml, respectively.None of the patients of the study cohort develop wound infection or wound dehiscence. There were no reported incidence of hepatic artery thrombosis among the patients using EVR.None of these patients that underwent major orthopedic surgeries showed delayed fracture union or non-union.

Conclusion:

EVR based immunosuppression was safe in LDLT recipients undergoing non-transplant surgeries. There was no incidence of wound infection or wound dehiscence. Our large scale findings suggest no correlation of EVR use and reported post-operative wound infections in recipients.

CITATION INFORMATION: Hsu S.-C, Thorat A, Jeng L.-B, Yang H.-R, Li P.-C, Yeh C.-C, Chen T.-H, Poon K.-S. Liver Transplant Recipients Undergoing Non-Transplant Surgeries and Everolimus Use as Primary Immunosuppressant- Busting the Myth of Wound Infection Due to mTOR Inhibitors. Am J Transplant. 2017;17 (suppl 3).

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