Sympathetic dystrophy associated with sirolimus therapy

Transplantation. 2008 Jan 27;85(2):290-2. doi: 10.1097/TP.0b013e3181601230.


The reflex sympathetic dystrophy syndrome (RSDS) in organ transplant recipients has only previously been reported in patients treated with calcineurin inhibitors. We retrospectively analyzed 393 renal transplant patients treated with sirolimus, 9 of whom developed RSDS. All the patients reported varying degrees of pain in the legs, affecting the knees, ankles, and/or feet, plus cutaneous erythema. The onset of pain ranged from 1-6 months after transplantation. At the time of diagnosis of RSDS, the mean serum creatinine was 1.4 mg/dL (range 1.0-1.7) and bone scintigraphy with 99mTc pyrophosphate showed increased uptake in all cases. The symptoms remitted 3-10 months after treatment (mean, 4 months) with calcitriol, with or without nifedipine or calcitonin, and in one case with suppression of sirolimus. We conclude that sirolimus therapy may induce RSDS in renal transplant recipients.

MeSH terms

  • Adult
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Kidney Transplantation / immunology*
  • Male
  • Middle Aged
  • Pain / etiology
  • Pain Measurement
  • Reflex Sympathetic Dystrophy / chemically induced*
  • Reflex Sympathetic Dystrophy / physiopathology
  • Retrospective Studies
  • Sirolimus / adverse effects*


  • Immunosuppressive Agents
  • Sirolimus