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Clinical Assistant Professor Department of Pharmacy Practice and Administration Ernest Mario School of Pharmacy Rutgers, The State University of New Jersey Piscataway, New Jersey Clinical Specialist Pharmacy Department Saint Barnabas Medical Center 94 Old Short Hills Road Livingston, New Jersey 07039-5672 FAX 973/322-5675 E-mail smathis{at}sbhcs.com
Published Online, January 13, 2003. www.theannals.com, DOI 10.1345/aph.1A128a
It is difficult to determine the incidence of dehiscence in liver recipients at the author's center from the case report,1 but the article identifies an important clinical consideration in determining the appropriate use of sirolimus in liver transplantation, at a time when published multicentered trial data are still lacking. Other reasons to avoid prescribing sirolimus early after liver transplantation were also recently elucidated. A prominent warning in the package insert now highlights an increased risk of mortality and graft loss when sirolimus is used with tacrolimus in de novo liver transplant recipients.4 An increased incidence of hepatic artery thrombosis leading to graft loss or death, generally occurring within 30 days after surgery, has also been noted when sirolimus is used with either tacrolimus or cyclosporine in de novo liver transplantation. These findings should be strongly considered by clinicians before administration of sirolimus to additional liver transplant recipients.
References
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