Gastrointestinal hemorrhage due to complicated gastroduodenal ulcer disease in liver transplant patients taking sirolimus

  1. Alastair D Smith1,
  2. Diane Bai1,
  3. Carlos E Marroquin2,
  4. Janet E Tuttle-Newhall2,
  5. Dev M Desai2,
  6. Bradley H Collins2,
  7. Andrew Muir1,
  8. Paul C Kuo2,
  9. John McHutchison1,
  10. Don C Rockey1

Article first published online: 14 FEB 2005

DOI: 10.1111/j.1399-0012.2005.00332.x

Issue

Clinical Transplantation

Clinical Transplantation

Volume 19, Issue 2, pages 250–254, April 2005

Additional Information

How to Cite

Smith, A. D., Bai, D., Marroquin, C. E., Tuttle-Newhall, J. E., Desai, D. M., Collins, B. H., Muir, A., Kuo, P. C., McHutchison, J. and Rockey, D. C. (2005), Gastrointestinal hemorrhage due to complicated gastroduodenal ulcer disease in liver transplant patients taking sirolimus. Clinical Transplantation, 19: 250–254. doi: 10.1111/j.1399-0012.2005.00332.x

Author Information

  1. 1

    Departments of  Medicine

  2. 2

     Surgery, Duke University Medical Center, Durham, NC, USA

*Don C. Rockey MD, Room 336, Sands Building, Box 3083, Duke University Medical Center, Durham, NC 27710, USA. Tel.: +919 684 8727; fax: +919 684 4983; e-mail: dcrockey@acpub.duke.edu

Publication History

  1. Issue published online: 1 MAR 2005
  2. Article first published online: 14 FEB 2005
  3. Accepted for publication 13 December 2004

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Keywords:

  • bleeding;
  • gastric ulcer;
  • rapamycin;
  • wound healing

Abstract:  Sirolimus is emerging as a popular immunosuppressive agent for patients undergoing solid organ and pancreatic cell transplantation. Here, we report the clinical courses of three patients receiving sirolimus who developed aggressive gastroduodenal ulcer disease. One patient died from massive gastrointestinal bleeding, and ulcers in the other two patients healed only after discontinuation of sirolimus. We propose that the mechanism underlying this severe ulcer diathesis, and poor ulcer healing, was linked to the well-known inhibitory effects of sirolimus on wound healing. We propose that sirolimus should be used carefully (or even withheld) in patients with known or previous ulcer disease, and further that it should be used prudently and/or in conjunction with aggressive prophylaxis therapy in those at risk for ulcer disease.

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