Venous Thromboembolic Disease after Lung Transplantation: SpecialFocus on Sirolimus

Background: Venous thromboembolism (VTE) is common after lung transplantation. We aimed to review our experience with VTE in lung transplant recipients, while paying attention to the use of sirolimus, a novel immunosuppressive agent that may have prothrombotic effects. Methods: A retrospective review of lung transplant recipients at the University of Pennsylvania from 2000 to 2006 was performed. Demographic data, acute and chronic rejection and survival were included. Clinically apparent VTE episodes and sirolimus utilization were noted. Results: 59/278 (21.2%) of patients developed VTE. There were no baseline differences in patients with and without VTE. Patients more than three months post-transplant had a higher rate of VTE on sirolimus vs. off (1.98% vs. 0.32% per month on vs. off sirolimus; p<0.001). Patients with VTE after lung transplantation had worse survival (p=0.001). Conclusions: VTE is a common complication after lung transplantation and patients with VTE have worse post-transplant survival. Sirolimus is associated with increased rate of VTE.