A comparison of sirolimus vs. calcineurin inhibitor‐based immunosuppressive therapies in liver transplantation

Summary Background Sirolimus is a potent immunosuppressive agent whose role in liver transplantation has not been well‐described. Aim To evaluate the efficacy and side‐effects of sirolimus‐based immunosuppression in liver transplant patients. Methods Retrospective analysis of 185 patients who underwent orthotopic liver transplantation. Patients were divided into three groups: group SA, sirolimus alone (n = 28); group SC, sirolimus with calcineurin inhibitors (n =56) and group CNI, calcineurin inhibitors without sirolimus (n = 101). Results One‐year patient and graft survival rates were 86.5% and 82.1% in group SA, 94.6% and 92.9% in group SC, and 83.2% and 75.2% in group CNI (P = N.S.). The rates of acute cellular rejection at 12 months were comparable among the three groups. At the time of transplantation, serum creatinine levels were significantly higher in group SA, but mean creatinine among the three groups at 1 month was similar. More patients in group SA required dialysis before orthotopic liver transplantation (group SA, 25%; group SC, 9%; group CNI, 5%; P = 0.008), but at 1 year, post‐orthotopic liver transplantation dialysis rates were similar. Conclusions Sirolimus given alone or in conjunction with calcineurin inhibitors appears to be an effective primary immunosuppressant regimen for orthotopic liver transplantation patients. Further studies to evaluate the efficacy and side‐effect profile of sirolimus in liver transplant patients are warranted.