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- W2979080975 abstract "Purpose: Discovered in the soil of Easter Island in the 1970s, sirolimus has become an increasing popular immunosuppresive agent to prevent rejection in many solid organ transplants as an alternative to calcineurin inhibitors due to the presumed decrease renal toxicity. As the use of sirolimus has increased, so have the number of identified toxicities including pulmonary, dermatologic and cardiac complications. There is little information with regards to sirolimus-induced hepatotoxicity. We present the case of a 34 year old man who developed abnormal liver function tests 6 years after his live-donor kidney transplant, 5 years after starting sirolimus with a strict hepatocellular pattern of isolated AST and ALT elevation. Withdrawal of other offending agents was attempted without resolution of his elevated transaminases. Serologic evaluation revealed no evidence of acute viral hepatitis. All markers of genetic and autoimmune causes of liver disease were negative. A biopsy was done which revealed moderate to severe diffuse inflamation with mild periportal fibrosis consistent with viral, autoimmune or drug induced hepatic injury. Based on the clinical picture and serologies taken withdrawal of sirolimus was performed and the liver function tests rapidly normalized over a two week period. Sirolimus is an important part of the armamentarium of transplant physicians. Sirolimus has been purported to improve renal function by reducing calcineurin associated nephrotoxicity. As well, sirolimus impairs VEGF and therefore may be useful in preventing the development of post-transplant malignancies such as kaposi's sarcoma and PTLD. However, as the use of sirolimus has increased so have the indentified toxicities. Hepatitis is another important complication that should be added to this list. Studies with other medications have shown that chronic medication associated hepatitis may progress to fulminant hepatic failure if it is failed to be identified. Therefore it is important to be aware and identify sirolimus-associated hepatotoxicity and to treat accordingly with the withdrawal of the medication.Figure: Liver biopsy at low power showing moderate hepatitis affecting both portal tracts and lobules." @default.
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- W2979080975 date "2008-09-01" @default.
- W2979080975 modified "2023-09-26" @default.
- W2979080975 title "Sirolimus-Induced Hepatotoxicity" @default.
- W2979080975 doi "https://doi.org/10.14309/00000434-200809001-00407" @default.
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