No major neurologic complications with sirolimus use in heart transplant recipients

Diederik Van De Beek, Walter K. Kremers, Sudhir S. Kushwaha, Christopher G.A. McGregor, Eelco F.M. Wijdicks

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


OBJECTIVE: To determine whether sirolimus therapy is associated with neurologic complications, including stroke, among heart transplant recipients. PATIENTS AND METHODS: We retrospectively studied patients who underwent heart transplant at Mayo Clinic's site in Rochester, MN, from January 1, 1988, through June 30, 2006. RESULTS: Of 313 patients in the cohort, the medical regimen in 116 patients (37%) was switched from cyclosporine-based therapy to sirolimus. The hazard ratio of sirolimus for any neurologic or psychiatric event was 1.94 (95% confidence interval, 0.67-4.29). This hazard ratio was driven mainly by the association between sirolimus and the development of tremor and depression. Cerebrovascular events occurred with a cumulative incidence of 14% but did not occur in any of the patients who received sirolimus therapy. There were no cases of posterior reversible encephalopathy syndrome with sirolimus use. CONCLUSION: No early or late episodes of major neurotoxicity occurred in heart transplant recipients using sirolimus immunosuppression. The absence of stroke and transient ischemic attacks in these high-risk transplant recipients treated with sirolimus is notable but needs confirmation in future studies.

Original languageEnglish (US)
Pages (from-to)330-332
Number of pages3
JournalMayo Clinic Proceedings
Issue number4
StatePublished - Apr 2009
Externally publishedYes

Bibliographical note

Funding Information:
Dr van de Beek is supported by grants from the Meerwaldt Foundation and the Netherlands Organization for Health Research and Development (ZonMw); NWO-Rubicon grant 2006 (019.2006.1.310.001) .

Copyright 2017 Elsevier B.V., All rights reserved.


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