Mammalian Target of Rapamycin Inhibitors and Wound Healing Complications in Kidney Transplantation: Old Myths and New Realities

Mammalian target of rapamycin inhibitors (mTOR-I) lacks nephrotoxicity, has antineoplastic effects, and reduces viral infections in kidney transplant recipients. Earlier studies reported a significant incidence of wound healing complications and lymphocele. This resulted in the uncomfortable willing...

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Bibliographic Details
Published in:Journal of transplantation 2022-02, Vol.2022, p.6255339-28
Main Authors: Mabood Khalil, Muhammad Abdul, Al-Ghamdi, Saeed M. G, Dawood, Ubaidullah Shaik, Ahmed Khamis, Said Sayed, Ishida, Hideki, Chong, Vui Heng, Tan, Jackson
Format: Article
Language:English
Subjects:
Antithymocyte globulin
Care and treatment
Complications and side effects
Infection control
Kidneys
Medical research
Medicine, Experimental
Organ transplant recipients
Rapamycin
Review
Transplantation
Virus diseases
Wound healing
Wounds and injuries
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Summary:Mammalian target of rapamycin inhibitors (mTOR-I) lacks nephrotoxicity, has antineoplastic effects, and reduces viral infections in kidney transplant recipients. Earlier studies reported a significant incidence of wound healing complications and lymphocele. This resulted in the uncomfortable willingness of transplant clinicians to use these agents in the immediate posttransplant period. As evidence and experience evolved over time, much useful information became available about the optimal use of these agents. Understandably, mTOR-I effects wound healing through their antiproliferative properties. However, there are a lot of other immunological and nonimmunological factors which can also contribute to wound healing complications. These risk factors include obesity, uremia, increasing age, diabetes, smoking, alcoholism, and protein-energy malnutrition. Except for age, the rest of all these risk factors are modifiable. At the same time, mycophenolic acid derivatives, steroids, and antithymocyte globulin (ATG) have also been implicated in wound healing complications. A lot has been learnt about the optimal dose of mTOR-I and their trough levels, its combinations with other immunosuppressive medications, and patients’ profile, enabling clinicians to use these agents appropriately for maximum benefits. Recent randomized control trials have further increased the confidence of clinicians to use these agents in immediate posttransplant periods.
ISSN:2090-0007
2090-0015
DOI:10.1155/2022/6255339