Warning over sirolimus in HCV-positive liver transplantation

Sirolimus, whether given at the time of liver transplantation (LT) or after, is associated with poorer outcomes in patients with hepatitis C virus (HCV) infection compared with those who do not take the immunosuppressant, shows a US study.

The findings help provide important information on the controversial use of mammalian target of rapamycin (mTOR) inhibitors as primary immunosuppressants after LT.

"The results of this analysis suggest that mTOR inhibitors should be used with great caution in LT recipients with HCV infections," write Michael Charlton (Mayo Clinic and Foundation, Rochester, Minnesota, USA) and colleagues in Liver Transplantation.

The study included 26,414 transplant patients, included in the Scientific Registry of Transplant Recipients. Overall, 12,589 had an underlying HCV infection and sirolimus was prescribed at discharge in 1685 patients. Patients were followed up at 6 months and annually thereafter.

Multivariate analysis showed that patients with HCV were 26% more likely to die within 3 years if they were given sirolimus at discharge compared with those who were not. However, in HCV-negative patients, there was no significant association between sirolimus and risk for mortality.

In comparison, the calcineurin inhibitor, tacrolimus was associated with a 26% reduction in the risk of 3-year mortality in HCV-positive patients and a 44% reduction in HCV-negative patients.

To minimize the likelihood that their findings were due to sirolimus being prescribed in the most high-risk patients, the authors conducted a propensity analysis, controlling for factors known to affect posttransplant survival. However, the influence of sirolimus on 3-year mortality persisted.

The authors also found that patients taking sirolimus for longer than a year and those that began treatment more than a year after surgery had reduced survival compared with those who took the immunosuppressant immediately after surgery but for less than a year.

In an accompanying editorial, Parul Agarwal and Michael Lucey (University of Wisconsin, Madison, USA) say that the study "sounds an important note of warning regarding the use of mTOR inhibitors in HCV-infected LT recipients."

However, they caution that the study has significant limitations and say that further research is needed.

"A greater understanding of the relative impact of available immunosuppressive agents on key posttransplant outcomes is one of the most pressing needs of the LT community," the authors concur.

Licensed from medwireNews with permission from Springer Healthcare Ltd. ©Springer Healthcare Ltd. All rights reserved. Neither of these parties endorse or recommend any commercial products, services, or equipment.

Kirsty Oswald

Written by

Kirsty Oswald

Kirsty has a B.Sc. in Human Sciences from University College London. After several years working as medical copywriter, she became a medical journalist and is now freelance. Kirsty also works part-time as an editor for a London-based charity. She is particularly interested in the social and cultural aspects of science.


Please use one of the following formats to cite this article in your essay, paper or report:

  • APA

    Oswald, Kirsty. (2018, August 23). Warning over sirolimus in HCV-positive liver transplantation. News-Medical. Retrieved on July 25, 2021 from https://www.news-medical.net/news/20120910/Warning-over-sirolimus-in-HCV-positive-liver-transplantation.aspx.

  • MLA

    Oswald, Kirsty. "Warning over sirolimus in HCV-positive liver transplantation". News-Medical. 25 July 2021. <https://www.news-medical.net/news/20120910/Warning-over-sirolimus-in-HCV-positive-liver-transplantation.aspx>.

  • Chicago

    Oswald, Kirsty. "Warning over sirolimus in HCV-positive liver transplantation". News-Medical. https://www.news-medical.net/news/20120910/Warning-over-sirolimus-in-HCV-positive-liver-transplantation.aspx. (accessed July 25, 2021).

  • Harvard

    Oswald, Kirsty. 2018. Warning over sirolimus in HCV-positive liver transplantation. News-Medical, viewed 25 July 2021, https://www.news-medical.net/news/20120910/Warning-over-sirolimus-in-HCV-positive-liver-transplantation.aspx.


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
You might also like... ×
Children of obese mothers at increased risk of fatty liver disease