Impaired Lower Extremity Wound Healing Secondary to Sirolimus After Kidney Transplantation

Abstract 

Purpose

Sirolimus is an immunosuppressive drug used as part of the drug regimen after kidney, liver, and heart transplantation. There have been numerous reports of transplant surgical wound healing complications secondary to sirolimus. The authors present a case of impaired wound healing in the lower extremity after kidney transplantation for a patient on sirolimus. This is one of the few reported cases that we are aware of that demonstrates the effects of sirolimus on wound healing at a nontransplant site.

Methods

A case highlighting aggressive limb-salvage modalities for a kidney transplant patient on sirolimus is presented. The subject was informed that data concerning the case would be submitted for publication. A brief review of the literature shows the wound healing problems previously associated with sirolimus.

Results

Despite all salvage techniques employed, including aggressive early debridement, forefoot offloading, IV antibiotics, negative pressure wound therapy, and hyperbaric oxygen therapy, the patient eventually went on to failure and a transtibial amputation.

Conclusion

Physicians specializing in wound care and limb salvage must be aware of the effects of sirolimus on wound healing and should consider modifications to these patients' immunosuppressive regimens.

Keywords: Sirolimus, Diabetes, Wound, Immunosuppression, Transplant, Introduction