Corticosteroid avoidance ameliorates lymphocele formation and wound healing complications associated with sirolimus therapy

C. C. Rogers, M. Hanaway, R. R. Alloway, J. W. Alexander, R. E. Boardman, J. Trofe, M. Gupta, Todd David Merchen, J. F. Buell, M. Cardi, P. Roy-Chaudhury, P. Succop, E. S. Woodle

Research output: Contribution to journalArticle

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Abstract

Introduction. Sirolimus (RAPA) and corticosteroids (CS) both inhibit wound healing. To evaluate the possibility that RAPA and CS have additive effects on wound healing, we evaluated the effects of corticosteroid avoidance (CSAV) on wound healing complications in patients treated with RAPA. Methods. One hundred nine patients treated with a CSAV regimen (no pretransplantation or posttransplantation CS) were compared with a historical control group (n = 72) that received cyclosporine (CsA), mycophenolate mofetil (MMF), and CS. The CSAV group received low-dose CsA, MMF, RAPA, and thymoglobulin induction. Complications were classified as follows: wound healing complications (WHC) or infectious wound complications (IWC). WHC included lymphocele, hernia, dehiscence, diastasis, and skin edge separation. IWC included wound abscess and empiric antibiotic therapy for wound erythema. Results. The CSAV group was largely CS-free: 11% of patients received CS for rejection, 12% of patients received CS for recurrent disease, and 85% of patients are currently off CS. The CSAV group had a significantly lower incidence of WHC (13.7% vs 28%; P =. 03) and lymphoceles (5.5% vs 16%; P =. 02) than the control group. There was no difference in the incidence of IWC between the 2 groups. Patients who received CSAV were 18% less likely (P =. 57) to develop any type of complication, 41% less likely (P =. 20) to develop a WHC, and 71% less likely (P =. 018) to develop a lymphocele. Conclusions. CSAV in a RAPA-based regimen results in a marked reduction in WHC and lymphoceles. Therefore, CSAV provides a promising approach for addressing WHC associated with RAPA therapy.

Original languageEnglish (US)
Pages (from-to)795-797
Number of pages3
JournalTransplantation Proceedings
Volume37
Issue number2
DOIs
StatePublished - Jan 1 2005
Externally publishedYes

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Lymphocele
Sirolimus
Wound Healing
Adrenal Cortex Hormones
Therapeutics
Wounds and Injuries
Mycophenolic Acid
Control Groups

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Rogers, C. C., Hanaway, M., Alloway, R. R., Alexander, J. W., Boardman, R. E., Trofe, J., ... Woodle, E. S. (2005). Corticosteroid avoidance ameliorates lymphocele formation and wound healing complications associated with sirolimus therapy. Transplantation Proceedings, 37(2), 795-797. https://doi.org/10.1016/j.transproceed.2004.12.076

Corticosteroid avoidance ameliorates lymphocele formation and wound healing complications associated with sirolimus therapy. / Rogers, C. C.; Hanaway, M.; Alloway, R. R.; Alexander, J. W.; Boardman, R. E.; Trofe, J.; Gupta, M.; Merchen, Todd David; Buell, J. F.; Cardi, M.; Roy-Chaudhury, P.; Succop, P.; Woodle, E. S.

In: Transplantation Proceedings, Vol. 37, No. 2, 01.01.2005, p. 795-797.

Research output: Contribution to journalArticle

Rogers, CC, Hanaway, M, Alloway, RR, Alexander, JW, Boardman, RE, Trofe, J, Gupta, M, Merchen, TD, Buell, JF, Cardi, M, Roy-Chaudhury, P, Succop, P & Woodle, ES 2005, 'Corticosteroid avoidance ameliorates lymphocele formation and wound healing complications associated with sirolimus therapy', Transplantation Proceedings, vol. 37, no. 2, pp. 795-797. https://doi.org/10.1016/j.transproceed.2004.12.076
Rogers, C. C. ; Hanaway, M. ; Alloway, R. R. ; Alexander, J. W. ; Boardman, R. E. ; Trofe, J. ; Gupta, M. ; Merchen, Todd David ; Buell, J. F. ; Cardi, M. ; Roy-Chaudhury, P. ; Succop, P. ; Woodle, E. S. / Corticosteroid avoidance ameliorates lymphocele formation and wound healing complications associated with sirolimus therapy. In: Transplantation Proceedings. 2005 ; Vol. 37, No. 2. pp. 795-797.
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abstract = "Introduction. Sirolimus (RAPA) and corticosteroids (CS) both inhibit wound healing. To evaluate the possibility that RAPA and CS have additive effects on wound healing, we evaluated the effects of corticosteroid avoidance (CSAV) on wound healing complications in patients treated with RAPA. Methods. One hundred nine patients treated with a CSAV regimen (no pretransplantation or posttransplantation CS) were compared with a historical control group (n = 72) that received cyclosporine (CsA), mycophenolate mofetil (MMF), and CS. The CSAV group received low-dose CsA, MMF, RAPA, and thymoglobulin induction. Complications were classified as follows: wound healing complications (WHC) or infectious wound complications (IWC). WHC included lymphocele, hernia, dehiscence, diastasis, and skin edge separation. IWC included wound abscess and empiric antibiotic therapy for wound erythema. Results. The CSAV group was largely CS-free: 11{\%} of patients received CS for rejection, 12{\%} of patients received CS for recurrent disease, and 85{\%} of patients are currently off CS. The CSAV group had a significantly lower incidence of WHC (13.7{\%} vs 28{\%}; P =. 03) and lymphoceles (5.5{\%} vs 16{\%}; P =. 02) than the control group. There was no difference in the incidence of IWC between the 2 groups. Patients who received CSAV were 18{\%} less likely (P =. 57) to develop any type of complication, 41{\%} less likely (P =. 20) to develop a WHC, and 71{\%} less likely (P =. 018) to develop a lymphocele. Conclusions. CSAV in a RAPA-based regimen results in a marked reduction in WHC and lymphoceles. Therefore, CSAV provides a promising approach for addressing WHC associated with RAPA therapy.",
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T1 - Corticosteroid avoidance ameliorates lymphocele formation and wound healing complications associated with sirolimus therapy

AU - Rogers, C. C.

AU - Hanaway, M.

AU - Alloway, R. R.

AU - Alexander, J. W.

AU - Boardman, R. E.

AU - Trofe, J.

AU - Gupta, M.

AU - Merchen, Todd David

AU - Buell, J. F.

AU - Cardi, M.

AU - Roy-Chaudhury, P.

AU - Succop, P.

AU - Woodle, E. S.

PY - 2005/1/1

Y1 - 2005/1/1

N2 - Introduction. Sirolimus (RAPA) and corticosteroids (CS) both inhibit wound healing. To evaluate the possibility that RAPA and CS have additive effects on wound healing, we evaluated the effects of corticosteroid avoidance (CSAV) on wound healing complications in patients treated with RAPA. Methods. One hundred nine patients treated with a CSAV regimen (no pretransplantation or posttransplantation CS) were compared with a historical control group (n = 72) that received cyclosporine (CsA), mycophenolate mofetil (MMF), and CS. The CSAV group received low-dose CsA, MMF, RAPA, and thymoglobulin induction. Complications were classified as follows: wound healing complications (WHC) or infectious wound complications (IWC). WHC included lymphocele, hernia, dehiscence, diastasis, and skin edge separation. IWC included wound abscess and empiric antibiotic therapy for wound erythema. Results. The CSAV group was largely CS-free: 11% of patients received CS for rejection, 12% of patients received CS for recurrent disease, and 85% of patients are currently off CS. The CSAV group had a significantly lower incidence of WHC (13.7% vs 28%; P =. 03) and lymphoceles (5.5% vs 16%; P =. 02) than the control group. There was no difference in the incidence of IWC between the 2 groups. Patients who received CSAV were 18% less likely (P =. 57) to develop any type of complication, 41% less likely (P =. 20) to develop a WHC, and 71% less likely (P =. 018) to develop a lymphocele. Conclusions. CSAV in a RAPA-based regimen results in a marked reduction in WHC and lymphoceles. Therefore, CSAV provides a promising approach for addressing WHC associated with RAPA therapy.

AB - Introduction. Sirolimus (RAPA) and corticosteroids (CS) both inhibit wound healing. To evaluate the possibility that RAPA and CS have additive effects on wound healing, we evaluated the effects of corticosteroid avoidance (CSAV) on wound healing complications in patients treated with RAPA. Methods. One hundred nine patients treated with a CSAV regimen (no pretransplantation or posttransplantation CS) were compared with a historical control group (n = 72) that received cyclosporine (CsA), mycophenolate mofetil (MMF), and CS. The CSAV group received low-dose CsA, MMF, RAPA, and thymoglobulin induction. Complications were classified as follows: wound healing complications (WHC) or infectious wound complications (IWC). WHC included lymphocele, hernia, dehiscence, diastasis, and skin edge separation. IWC included wound abscess and empiric antibiotic therapy for wound erythema. Results. The CSAV group was largely CS-free: 11% of patients received CS for rejection, 12% of patients received CS for recurrent disease, and 85% of patients are currently off CS. The CSAV group had a significantly lower incidence of WHC (13.7% vs 28%; P =. 03) and lymphoceles (5.5% vs 16%; P =. 02) than the control group. There was no difference in the incidence of IWC between the 2 groups. Patients who received CSAV were 18% less likely (P =. 57) to develop any type of complication, 41% less likely (P =. 20) to develop a WHC, and 71% less likely (P =. 018) to develop a lymphocele. Conclusions. CSAV in a RAPA-based regimen results in a marked reduction in WHC and lymphoceles. Therefore, CSAV provides a promising approach for addressing WHC associated with RAPA therapy.

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