Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Class-related, concentration-dependent adverse effects associated with mTOR inhibitors (mTORi) include wound complications such as impaired wound healing, incisional hernias, hepatic artery thrombosis, and lymphocele which are a concern for transplant recipients requiring surgery post-transplant. Data is limited regarding the association of mTORi with wound complications from subsequent surgeries after liver transplant. Due to limited evidence and varying practices, the impact of holding (or continuing) mTORi on wound healing peri-surgery in liver transplant recipients remains unknown. Our goal is to describe peri-operative mTORi management in post-liver transplant recipients requiring surgery and compare wound complication rates between holding versus continuing mTORi.
*Methods: This is a single center, retrospective, descriptive study of adult liver transplant recipients between January 1, 2013 and December 1, 2018. Patients were included that received mTORi (everolimus or sirolimus) as part of their immunosuppression regimen and underwent a post-transplant surgical procedure.
*Results: We followed mTORi management of 43 liver transplant recipients that underwent 118 non-transplant surgical procedures. Of the total 118 procedures, 44 were major and 74 were minor surgeries. The mean age at time of surgery was 60.1±7.6 years, 81% (n=35) were male, 91% (n=39) were non-black, and 40% (n=17) were diabetic. The mTORi was continued in 86 surgeries overall (69 (93.2%) minor and 17 (38.6%) major). Twenty-one surgical complications were documented in 17 patients, of which nine remained on mTORi at the time of surgery with a median trough level of 3.7 ng/mL (IQR 2.9-8.2). Dual, independent surgeon review attributed none of the complications to mTORi use. Having major surgery was associated with wound complications post-surgery (OR [95%CI] 0.16 [0.05, 0.58], p=0.005), while holding (versus continuing) mTORi was not (OR [95%CI] 1.88 [0.55, 6.36], p=0.31).
*Conclusions: Continuing mTORi for minor surgeries was common and appeared safe; further investigation of mTORi management for major surgeries is warranted.
To cite this abstract in AMA style:Neuhaus K, Eghtesad B, Hashimoto K, Spinner M, Bollinger J, Eckardt J. MTOR Inhibitor Management and Wound Complications in Liver Transplant Recipients Undergoing Subsequent Surgeries [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/mtor-inhibitor-management-and-wound-complications-in-liver-transplant-recipients-undergoing-subsequent-surgeries/. Accessed November 26, 2020.
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