Do I need to start taking sirolimus after a liver transplant?

A clinical trial showed increased mortality in stable liver transplant patients after switching from a calcineurin inhibitor-based immunosuppressive regimen to sirolimus. A 2019 cohort study of nearly 10,000 lung transplant recipients in the United States showed that immunosuppressive therapy with sirolimus + tacrolimus instead of mycophenolate mofetil + tacrolimus started one year after transplantation can significantly improve long-term survival rates.

An international study randomized liver transplant recipients to receive either rapamycin plus tacrolimus or tacrolimus alone. There was no difference in the incidence of acute rejection, but the incidence of graft loss, death, and hepatic artery thrombosis was higher with sirolimus, leading to early termination of the study, noting that the combination of sirolimus with tacrolimus was associated with mortality and excess mortality, with many patients having signs of infection at or near death. Hepatic artery thrombosis usually occurs within 30 days after transplantation and most results in graft loss or death.

SirolimusThe original drug has been launched in China and has entered the scope of Class B medical insurance. SpecificationsThe price of each box of 1mg*10 tablets is around RMB 400. The original sirolimus drug has also been launched overseas. The price of the Turkish version of Specifications1mg*100 tablets per box is around RMB 2,000 (the price may fluctuate due to exchange rates). The ingredients of the original drugs marketed in China are basically the same as those of foreign original drugs. Currently, there are no generic sirolimus drugs produced in other countries.