mTOR Inhibitors and their Role in Modern Concepts of Immunosuppression

Excerpt

Schwarz et al. [1], from the Department of Hepatobiliary and Liver Transplantation Surgery, Hospital Saint Antoine, Paris, report in this issue on major thoracic and/or abdominal surgery performed nine times in six liver transplant recipients, without discontinuation of mammalian target of rapamycin (mTOR) for baseline immunosuppression. Sirolimus or everolimus were given in three patients each; trough levels were 8–10 ng/ml for sirolimus and 6–8 ng/ml for everolimus. In addition, five patients received mycophenolate mofetil, while one patient received cyclosporine. No major complications were observed and none that could be particularly attributed to mTOR inhibitors. The findings demonstrate that major surgery is very feasible in patients receiving antiproliferative immunosuppressive agents without mTOR cessation, and the rate of complications does not exceed that observed in major surgery. The presented findings are important, even though they are from a single center and only a small patient population, particularly since single-center reports and single-center studies using sirolimus fostered the current opinion that mTOR inhibitors increase surgical complications [2, 3]. In order to understand the background of this global rumor, a closer look into the facts might be helpful. …