Airway anastomotic dehiscence associated with use of sirolimus immediately after lung transplantation

Transplantation. 2003 May 15;75(9):1437-43. doi: 10.1097/01.TP.0000064083.02120.2C.


Goal: The goal of this study was to assess the efficacy of sirolimus in lung-transplant recipients.

Methods: The study was designed as a single center, consecutive case study of lung-transplant recipients treated with sirolimus, tacrolimus, and prednisone. All study subjects also received an HMG-CoA reductase inhibitor, and prophylaxis for cytomegalovirus and Pneumocystis carinii.

Results: A total of 15 subjects were enrolled in the study. Within 6 months, significant airway complications occurred in four subjects, three of whom died. At that point, the investigators terminated enrollment in the study. The study population was compared retrospectively with a group of 83 consecutive lung recipients treated with cyclosporine (n=64) or tacrolimus (n=19), mycophenolate mofetil, and prednisone. This confirmed an increased incidence of airway dehiscence and reduced survival in the sirolimus-treated patients. Sirolimus-treated patients had a low incidence of acute rejection. No significant differences were noted in the incidence of bacterial or fungal bronchopulmonary infections.

Conclusions: We observed an unexpectedly high incidence of postoperative airway dehiscence in lung-transplant recipients treated with sirolimus, in combination with tacrolimus, prednisone, and an HMG-CoA inhibitor. Further studies will be needed to determine the safety and efficacy of using sirolimus after complete airway healing has occurred.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bronchi / surgery*
  • Female
  • Graft Rejection
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Lung Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Sirolimus / adverse effects*
  • Sirolimus / blood
  • Surgical Wound Dehiscence / etiology*
  • Tacrolimus / adverse effects
  • Tacrolimus / blood


  • Immunosuppressive Agents
  • Sirolimus
  • Tacrolimus